Purchase Order Orthodontist in United States San Francisco –Free Word Template Download with AI
Bay Area Orthodontic Supply & Equipment Co.
1420 Market Street, Suite 850, United States San Francisco, CA 94102
Phone: (415) 555-0192 | Email: [email protected]
BUYER INFORMATION (Orthodontist Practice)| Practice Name: Golden Gate Orthodontic Associates | Attn: Dr. Margaret Chen, DMD, MS – Lead Orthodontist |
| Address: 2200 Fillmore Street, Floor 3, United States San Francisco, CA 94115 | Phone: (415) 555-7734 |
| Tax ID (EIN): 94-2837461 | CA Resale Certificate: CDT-8829104 |
| Company: Pacific Dental & Orthodontic Distribution, Inc. | Attn: Mr. David Okafor, Regional Sales Director |
| Address: 780 Harbor Bay Parkway, Alameda, United States San Francisco Bay Area, CA 94502 | Phone: (510) 555-3318 |
| Tax ID (EIN): 94-5561203 | Contact Email: [email protected] |
| Item # | Description | SKU | Qty | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|---|
| 1 | Self-Ligating Orthodontic Brackets, Ceramic, 0.022" Slot – Full Arch Set (32 pcs) | SLB-CER-022 | 25 | $189.50 | $4,737.50 |
| 2 | NiTi Archwires, Round, 0.014"–0.022" Assorted Pack (100 wires) | NIT-RTD-ASS | 40 | $62.00 | $2,480.00 |
| 3 | Clear Aligner Trays, BPA-Free PETG, Custom Molded – 20-Step Series | CLR-ALN-20S | 15 | $345.00 | $5,175.00 |
| 4 | Orthodontic Bonding Agent, Light-Cure, 30 mL Bottle | ORT-BND-30M | 60 | $28.75 | $1,725.00 |
| 5 | Interproximal Reduction (IPR) Strips, Medium Grit, 50-Count Box | IPR-STR-MED | 30 | $14.25 | $427.50 |
| 6 | Orthodontic Elastomeric Ligatures, Assorted Colors, 1000-Count Jar | ORT-ELT-1K | 50 | $9.80 | $490.00 |
| 7 | CBCT Imaging Film, 17x17 cm, 100-Pack (for intraoral radiography) | CBT-FIL-1717 | 12 | $112.00 | $1,344.00 |
| 8 | Orthodontic Impression Material, Polyvinyl Siloxane (PVS), 500 mL Syringe | PVS-IMP-500 | 35 | $41.50 | $1,452.50 |
| 9 | Retainer Wire, Stainless Steel, 0.016" x 0.024", 36" Length | RET-WIR-016 | 100 | $3.25 | $325.00 |
| 10 | Orthodontic Separator Rings, Stainless Steel, 1000-Count Box | ORT-SEP-1K | 20 | $18.90 | $378.00 |
| Subtotal: | $18,534.50 | ||||
| California Sales Tax (Exempt – Resale Cert. CDT-8829104): | $0.00 | ||||
| Freight & Handling (United States San Francisco Metro): | $215.00 | ||||
| TOTAL AMOUNT DUE (USD): | $18,749.50 | ||||
- Delivery: All items listed in this Purchase Order shall be delivered to the Orthodontist practice address at 2200 Fillmore Street, Floor 3, United States San Francisco, CA 94115 within fourteen (14) business days of the date of this Purchase Order. Delivery shall be made between the hours of 8:00 AM and 4:00 PM, Monday through Friday, excluding federal holidays observed in the State of California.
- Payment: Payment of the total amount of $18,749.50 USD shall be made via ACH transfer to the seller's designated account within thirty (30) days of the date of invoice. Late payments shall accrue interest at a rate of 1.5% per month or the maximum rate permitted under California law, whichever is lower.
- Quality Assurance: All orthodontic products supplied under this Purchase Order must comply with the standards set forth by the American Dental Association (ADA) and the Food and Drug Administration (FDA). The Orthodontist buyer reserves the right to inspect all goods upon receipt and reject any items that do not meet the specified quality, quantity, or packaging requirements.
- Warranty: The seller warrants that all goods are new, unused, and free from defects in material and workmanship. A minimum twelve (12) month warranty is provided on all equipment and consumables. Any defective items must be reported to the seller within thirty (30) days of delivery for replacement or credit.
- Regulatory Compliance: The seller acknowledges that all orthodontic supplies and devices are subject to FDA 510(k) clearance or exemption as applicable. The seller shall provide all necessary regulatory documentation, including lot numbers, expiration dates, and certificates of analysis, upon request by the Orthodontist buyer or any regulatory authority in the United States.
- Intellectual Property: All trademarks, patents, and proprietary designs associated with the orthodontic products listed herein remain the property of their respective manufacturers. This Purchase Order does not grant any license or right beyond the purchase and use of the goods.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of California, United States. Any disputes arising hereunder shall be subject to the exclusive jurisdiction of the state or federal courts located in San Francisco County, United States San Francisco.
- Force Majeure: Neither party shall be liable for delays or failures in performance resulting from causes beyond their reasonable control, including but not limited to natural disasters, supply chain disruptions, or government-mandated closures affecting the United States San Francisco metropolitan area.
- Confidentiality: Both parties agree to maintain the confidentiality of all pricing, business terms, and patient-related information exchanged in connection with this Purchase Order. This obligation shall survive the termination of this agreement for a period of three (3) years.
- Amendments: No modification or amendment to this Purchase Order shall be valid unless made in writing and signed by authorized representatives of both the Orthodontist buyer and the seller.
1. The Orthodontist buyer requires all ceramic brackets to be shade-matched to A2 per the VITA classical shade guide. Please confirm shade availability prior to shipment.
2. Clear aligner trays must be custom-molded per the digital STL files provided separately via secure upload to the seller's portal. Files are labeled "GGOA-Aligner-June2025."
3. All PVS impression material must have a minimum expiration date of eighteen (18) months from the date of delivery.
4. Delivery access: The receiving dock is located at the rear of the building on Fillmore Street. Please call (415) 555-7734 upon arrival for gate access. The Orthodontist office staff will be available to sign for receipt.
5. This Purchase Order is part of the quarterly supply agreement (Contract No. GGOA-Q2-2025) between Golden Gate Orthodontic Associates and Pacific Dental & Orthodontic Distribution, Inc.
Authorized by (Buyer – Orthodontist):
Dr. Margaret Chen, DMD, MSLead Orthodontist, Golden Gate Orthodontic Associates
Date: ______________________
Accepted by (Seller):
David OkaforRegional Sales Director, Pacific Dental & Orthodontic Distribution, Inc.
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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