Purchase Order Orthodontist in United States Los Angeles –Free Word Template Download with AI

Purchasing Party (Buyer)

Westside Orthodontist Group, LLC

4820 Wilshire Boulevard, Suite 310

Los Angeles, California 90036

United States of America

Tax ID (EIN): 82-4471903

Contact: Dr. Margaret Chen, DMD, MS

Phone: (213) 555-0187

Email: [email protected]

Supplier (Vendor)

Pacific Dental Supply Co., Inc.

1200 S. Grand Avenue, Building C

Los Angeles, California 90015

United States of America

Tax ID (EIN): 74-2298341

Contact: Robert Tanaka, Sales Director

Phone: (323) 555-0442

Email: [email protected]

NOTE: This Purchase Order is issued by Westside Orthodontist Group, LLC, a licensed orthodontist practice operating in Los Angeles, California, United States. All goods and services referenced herein are intended for use in orthodontic patient care, clinical operations, and administrative functions at our Los Angeles facility. All transactions are governed by the commercial laws of the State of California and the United States of America.

Item #	Description	Qty	Unit	Unit Price (USD)	Line Total (USD)
001	Self-Ligating Orthodontic Bracket System (Aesthetic Ceramic), 16-piece sets for upper and lower arches – for use by the orthodontist team in Los Angeles	250	sets	$42.50	$10,625.00
002	NiTi Arch Wires, 0.014" to 0.022" rectangular, 18" length – orthodontist clinical supply	500	packs	$8.75	$4,375.00
003	3D Intraoral Scanner (iTero Element 5) – digital imaging equipment for the orthodontist practice in Los Angeles	2	units	$18,500.00	$37,000.00
004	Orthodontic Elastomeric Ligatures, assorted colors, 1000-count boxes	200	boxes	$12.30	$2,460.00
005	Clear Aligner Retainers (Thermoplastic), custom-molded for orthodontist patient follow-up in Los Angeles	1,000	pairs	$6.20	$6,200.00
006	Orthodontic Bonding Agent & Etchant Kit (35% Phosphoric Acid), 500ml bottles	80	bottles	$24.90	$1,992.00
007	Panoramic X-Ray Imaging Unit (Cephalometric) – diagnostic equipment for the orthodontist clinic	1	unit	$42,000.00	$42,000.00
008	Orthodontic Separation Spacers, stainless steel, 1000-count	150	boxes	$9.40	$1,410.00
009	Professional Orthodontic Chair (Hydraulic, with integrated light and instrument tray) – for the Los Angeles orthodontist treatment room	3	units	$12,800.00	$38,400.00
010	Orthodontic Wax & Patient Comfort Kits (braces relief, oral rinse, instruction cards)	2,000	kits	$3.15	$6,300.00

Subtotal	$150,762.00
California Sales Tax (7.25% – Los Angeles County)	$10,930.25
Freight & Installation (within Los Angeles, United States)	$2,150.00
Equipment Calibration & Setup Fee	$1,800.00
GRAND TOTAL (USD)	$165,642.25

Payment Terms: Net 30 days from the date of invoice. Payment shall be made via ACH transfer to the vendor's designated bank account in the United States. Late payments shall accrue interest at 1.5% per month as permitted under California commercial code.
Delivery: All items shall be delivered to the orthodontist practice located at 4820 Wilshire Boulevard, Suite 310, Los Angeles, California 90036, United States. Delivery must be completed no later than July 15, 2025. The vendor is responsible for all shipping, handling, and insurance of goods in transit within the United States.
Quality & Compliance: All orthodontic materials and equipment must be FDA-approved and compliant with the American Association of Orthodontists (AAO) standards. The orthodontist practice in Los Angeles requires that all brackets, wires, and imaging devices carry valid CE and FDA 510(k) clearances. Certificates of conformity must accompany each shipment.
Warranty: All capital equipment (3D scanners, X-ray units, orthodontic chairs) shall carry a minimum 3-year manufacturer's warranty with on-site service coverage in the Los Angeles metropolitan area. Consumable orthodontic supplies are warranted to be free from defects at the time of delivery.
Installation & Training: The vendor shall provide on-site installation of all capital equipment at the orthodontist's Los Angeles office. A minimum of 8 hours of hands-on training for the orthodontist team (including Dr. Chen, two associate orthodontists, and four dental hygienists) shall be included at no additional cost.
Return Policy: Unused orthodontic consumables in original, unopened packaging may be returned within 60 days of delivery for a full refund, less a 5% restocking fee. Capital equipment returns require prior written authorization from the purchasing orthodontist practice.
Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of California and applicable federal laws of the United States of America. Any disputes shall be resolved through binding arbitration in Los Angeles, California, in accordance with the rules of the American Arbitration Association.
Confidentiality: The vendor acknowledges that patient records, treatment plans, and orthodontic case data associated with this Purchase Order are protected under HIPAA (Health Insurance Portability and Accountability Act) and California Confidentiality of Medical Information Act (CMIA). No patient-identifiable information shall be disclosed.
Force Majeure: Neither party shall be liable for delays caused by acts of God, natural disasters (including earthquakes common to the Los Angeles region), government actions, or other events beyond reasonable control, provided written notice is given within 5 business days.
Validity: This Purchase Order is valid for acceptance within 14 calendar days of the issue date. After this period, pricing and availability are subject to renegotiation between the orthodontist practice and the vendor.

Authorized by – Purchasing Party

Westside Orthodontist Group, LLC

Dr. Margaret Chen, DMD, MS
Lead Orthodontist & Practice Owner
Los Angeles, California, United States
Signature & Date: ___________________________

Accepted by – Vendor

Pacific Dental Supply Co., Inc.

Robert Tanaka
Sales Director
Los Angeles, California, United States
Signature & Date: ___________________________ ⬇️ Download as DOCX Edit online as DOCX

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