Purchase Order Orthodontist in United States New York City –Free Word Template Download with AI
Manhattan Orthodontic Excellence, PLLC
245 Park Avenue South, Suite 1200, United States New York City, NY 10003
Phone: (212) 555-0187 | Fax: (212) 555-0188 | Email: [email protected]
NYC Department of Health & Mental Hygiene License No. 4471-2024 | NYS Board of Regents Orthodontist License No. OR-88231
| Item # | Description | SKU / Part No. | Qty | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|---|
| 1 | Self-Ligating Orthodontic Brackets, 0.022" Slot, Stainless Steel (per 100-pack) – for use by the Orthodontist in fixed appliance therapy | SLB-022-SS-100 | 24 | $385.00 | $9,240.00 |
| 2 | NiTi Archwires, 0.014" to 0.021" x 0.025" Assorted Kit (per 50-pack) | NITI-ARCH-50 | 18 | $212.50 | $3,825.00 |
| 3 | Clear Aligner Trays, BPA-Free PETG Material, Custom-Molded (per 30-set) | CA-TRAY-30 | 12 | $475.00 | $5,700.00 |
| 4 | Orthodontic Elastic Ligatures, Assorted Colors (per 5000-count box) | EL-ORTHO-5K | 30 | $68.00 | $2,040.00 |
| 5 | Cephalometric X-Ray Film, 10" x 12", 200-speed (per 100-sheet box) | CX-1012-200 | 10 | $145.00 | $1,450.00 |
| 6 | Digital Intraoral Scanner Replacement Tips, Universal Fit (per 10-pack) | DIS-TIP-10 | 8 | $320.00 | $2,560.00 |
| 7 | Orthodontic Bonding Agent, Acid-Etch System (per 25-bottle case) | BOND-ORTHO-25 | 6 | $198.00 | $1,188.00 |
| 8 | Patient Retainer Cases, Hard & Soft, Assorted (per 100-pack) | RET-CASE-100 | 15 | $89.00 | $1,335.00 |
| 9 | Orthodontic Separator Rings, 0.010" x 0.020" (per 2000-count box) | SEP-010-2K | 20 | $54.00 | $1,080.00 |
| 10 | CBCT Imaging Calibration Phantom, Annual Recertification Kit | CBCT-CAL-2025 | 2 | $1,250.00 | $2,500.00 |
| Subtotal: | $30,918.00 |
| NYC Sales Tax (8.875%): | $2,744.00 |
| Shipping & Handling (United States New York City delivery): | $485.00 |
| Grand Total (USD): | $34,147.00 |
1. Scope of Purchase Order: This Purchase Order is issued by Manhattan Orthodontic Excellence, PLLC, a licensed orthodontic practice operating in the United States New York City, for the procurement of orthodontic consumables, imaging materials, and equipment accessories. All items listed herein are intended for clinical use by the supervising Orthodontist and supporting dental team in the provision of orthodontic care to patients in the New York City metropolitan area.
2. Delivery Requirements: The vendor shall deliver all items to the practice address located at 245 Park Avenue South, Suite 1200, United States New York City, NY 10003, no later than July 1, 2025. Delivery must be made between the hours of 8:00 AM and 4:00 PM, Monday through Friday. The vendor is responsible for all freight charges and insurance during transit. All orthodontic materials must be shipped in temperature-controlled packaging to ensure the integrity of bonding agents and elastic ligatures.
3. Quality and Compliance: All products must comply with the Food and Drug Administration (FDA) regulations for medical devices and dental materials. The Orthodontist at this practice requires that all brackets, wires, and aligner materials carry valid FDA 510(k) clearance or equivalent certification. Materials must meet the standards set forth by the American Association of Orthodontists (AAO) and the New York State Department of Health. The vendor warrants that all items are new, unused, and within their stated shelf life with a minimum of eighteen (18) months remaining at the time of delivery.
4. Payment Terms: Payment shall be made within thirty (30) calendar days of receipt of a valid invoice and confirmed delivery of all line items. Payment will be processed via ACH transfer to the vendor's designated bank account. Late payments shall accrue interest at a rate of 1.5% per month. The vendor must provide a detailed invoice referencing this Purchase Order number (PO-2025-00472) for processing.
5. Inspection and Acceptance: Upon delivery to the United States New York City practice location, the receiving staff will inspect all items for damage, correct quantity, and proper labeling. Any discrepancies, shortages, or damaged goods must be reported to the vendor within five (5) business days of delivery. The Orthodontist or designated practice manager must sign the delivery receipt to confirm acceptance. Rejected items will be returned at the vendor's expense.
6. Cancellation and Modification: This Purchase Order may be modified or cancelled in writing by either party prior to the vendor's shipment of goods. Cancellations after shipment will be subject to a 15% restocking fee. Any changes to quantities, specifications, or delivery dates must be approved in writing by the purchasing agent of the Orthodontist practice.
7. Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of New York, United States. Any disputes arising from this Purchase Order shall be subject to the exclusive jurisdiction of the state and federal courts located in New York County, United States New York City.
8. Confidentiality: The vendor acknowledges that pricing, patient-related information, and practice operational details shared in connection with this Purchase Order are confidential and shall not be disclosed to third parties without written consent from the Orthodontist practice owner.
Note: This Purchase Order is subject to the New York City Department of Health and Mental Hygiene regulations governing the procurement of dental and orthodontic supplies. All orthodontic materials must be stored in accordance with NYC building and health codes. The supervising Orthodontist (Dr. Elena Vasquez, DDS, MS, Board-Certified Orthodontist) retains final authority over the acceptance of all clinical materials listed in this document.Prepared by (Purchasing Agent):
Michael TorresPractice Operations Manager
Manhattan Orthodontic Excellence, PLLC
Date: ______________________
Approved by (Orthodontist / Practice Owner):
Dr. Elena Vasquez, DDS, MSBoard-Certified Orthodontist
Manhattan Orthodontic Excellence, PLLC
United States New York City
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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