Purchase Order Orthodontist in United States Houston –Free Word Template Download with AI
ClearPath Orthodontics & Dental Group
4820 Westheimer Road, Suite 310, United States Houston, Texas 77056
Phone: (713) 555-0142 | Email: [email protected]
Texas Business License No. TX-2024-88731 | NPI: 1942876503
| Item # | Description | SKU / Part No. | Qty | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|---|
| 1 | Self-Ligating Orthodontic Brackets, 0.022" Slot, Stainless Steel (Pack of 100) | APX-SLB-022-100 | 24 | $189.99 | $4,559.76 |
| 2 | NiTi Archwires, 0.014" x 0.025", 18" Length (Box of 50) | APX-NITI-1425-50 | 18 | $142.50 | $2,565.00 |
| 3 | Ceramic Orthodontic Brackets, Aesthetic Clear, 0.022" (Pack of 60) | APX-CER-022-60 | 12 | $312.00 | $3,744.00 |
| 4 | Orthodontic Elastics, 3/16" x 5/16", Assorted Colors (Case of 2,000) | APX-ELAS-316-2000 | 30 | $28.75 | $862.50 |
| 5 | Orthodontic Bonding Adhesive, Light-Cure, 30g Syringe (Pack of 10) | APX-BOND-LC-30G-10 | 8 | $96.00 | $768.00 |
| 6 | Orthodontic Pliers Set – 12-Piece Professional Kit (Weingart, How, Ball-Tip) | APX-PLRS-12PK | 4 | $485.00 | $1,940.00 |
| 7 | Intraoral Scanner Replacement Tips, Universal Fit (Pack of 20) | APX-SCAN-TIP-20 | 6 | $215.00 | $1,290.00 |
| 8 | Orthodontic Wax, Patient-Use, 1g Sticks (Box of 200) | APX-WAX-1G-200 | 15 | $34.00 | $510.00 |
| 9 | 3D Digital Impay Tray, Thermoplastic, Universal (Set of 10) | APX-IMPAY-UNI-10 | 10 | $67.50 | $675.00 |
| 10 | Orthodontic Ligature Wires, 0.010" x 0.010", 18" (Box of 100) | APX-LIG-1010-100 | 20 | $52.00 | $1,040.00 |
| Subtotal: | $18,954.26 | ||||
| Texas Sales Tax (8.25%): | $1,563.73 | ||||
| Freight & Handling (United States Houston Delivery): | $285.00 | ||||
| TOTAL AMOUNT DUE (USD): | $20,802.99 | ||||
- This Purchase Order is issued by ClearPath Orthodontics & Dental Group, a licensed orthodontic practice operating in United States Houston, Texas, and constitutes a binding agreement upon acceptance by the vendor.
- All items listed herein are intended for use by the Orthodontist and clinical support staff at our United States Houston location. Products must meet or exceed FDA clearance standards for orthodontic devices and materials.
- Delivery of all goods shall be made to the shipping address listed above in United States Houston. The vendor is responsible for all transit risk until goods are received and signed for at the destination facility.
- Payment shall be remitted within thirty (30) calendar days of the date of this Purchase Order via ACH transfer to the vendor's designated account. Late payments shall accrue interest at 1.5% per month.
- The vendor warrants that all orthodontic supplies, brackets, wires, adhesives, and instruments listed in this Purchase Order are new, unused, and free from defects in material and workmanship for a period of twelve (12) months from the date of delivery.
- Any discrepancies in quantity, quality, or specification must be reported to the purchasing department of this Orthodontist practice within five (5) business days of receipt. Failure to report within this window shall constitute acceptance of the goods as delivered.
- This Purchase Order is governed by the laws of the State of Texas and the federal regulations applicable to medical device procurement in the United States. Any disputes arising from this order shall be resolved in the courts of Harris County, United States Houston, Texas.
- The vendor shall maintain current FDA registration and 510(k) clearance documentation for all orthodontic products supplied under this order. Copies of such documentation must accompany each shipment to our United States Houston facility.
- Partial shipments are not authorized unless expressly approved in writing by the purchasing manager of this Orthodontist practice. All line items must arrive in a single consolidated delivery.
- This Purchase Order may not be assigned or transferred by the vendor without prior written consent from ClearPath Orthodontics & Dental Group, United States Houston.
For ClearPath Orthodontics & Dental Group (Buyer)
Dr. Margaret L. Chen, DDS, MS – Lead Orthodontist
Signature
Date: ____________________
For Apex Orthodontic Supply Co. (Vendor)
Authorized Representative
Signature
Date: ____________________
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