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Purchase Order Orthodontist in Venezuela Caracas –Free Word Template Download with AI

Orthodontist Professional Services & Clinical Supplies

Issued for: Venezuela Caracas – Metropolitan District

Document Reference: PO-VC-2025-0847

Purchase Order No.: PO-VC-2025-0847

Date of Issue: June 12, 2025

Required Delivery Date: July 01, 2025

Payment Terms: Net 30 Days

Currency: USD (US Dollars)

Incoterms: DDP – Venezuela Caracas

1. BUYER INFORMATION (Receiving Party)
Entity Name: Clínica Ortodóntica Los Palos Grandes, C.A.
Address: Av. Francisco de Miranda, Torre Empresarial, Piso 12, Los Palos Grandes, Venezuela Caracas, 1060
RIF: J-40287651-3
Contact Person: Dr. María Fernanda Rojas, Lead Orthodontist
Phone: +58 (212) 555-7842
Email: [email protected]
2. SUPPLIER / VENDOR INFORMATION
Entity Name: OrthoSupply International, S.A. de C.V.
Address: Blvd. Manuel Ávila Camacho 1250, Col. Lomas Altas, Guadalajara, Jalisco, México
Tax ID: RFC: OSI140520AB7
Contact Person: Lic. Carlos Mendoza, Regional Sales Director
Phone: +52 (33) 555-9103
Email: [email protected]
3. LINE ITEMS – Orthodontist Clinical Supplies & Equipment
Item # Description Qty Unit Unit Price (USD) Total (USD)
001 Self-ligating orthodontic brackets, 0.022" slot, stainless steel – 200 sets (for Orthodontist use in fixed appliance therapy) 200 sets 18.50 3,700.00
002 NiTi archwires, 0.014" to 0.022" rectangular, 18" length – 500 units 500 units 3.20 1,600.00
003 Orthodontic elastics, 1/16" to 3/16" assortment, 5,000 pieces per box – 10 boxes 10 boxes 45.00 450.00
004 Ceramic composite brackets, 0.022" slot, 100 sets (aesthetic Orthodontist treatment) 100 sets 24.00 2,400.00
005 Orthodontic bonding kit (primer, adhesive, curing light tips) – 25 kits 25 kits 62.00 1,550.00
006 Portable intraoral scanner, 3D digital impression system (for Orthodontist digital workflow) 1 unit 12,800.00 12,800.00
007 Orthodontic forceps, pliers, and extraction instruments – 15-piece professional set 3 sets 380.00 1,140.00
008 Clear aligner trays, BPA-free thermoplastic, 300 trays (for Orthodontist clear aligner therapy in Venezuela Caracas patients) 300 trays 8.75 2,625.00
009 Orthodontic wax, tubes of 10g, 200 tubes 200 tubes 1.20 240.00
010 Professional Orthodontist continuing education license – 1-year access to digital CE platform 5 licenses 350.00 1,750.00
SUBTOTAL 28,255.00
Import Duty & IVA (16%) – Venezuela Caracas Customs 4,520.80
Freight & Insurance to Venezuela Caracas 1,180.00
GRAND TOTAL (USD) 33,955.80
4. TERMS AND CONDITIONS
  1. This Purchase Order constitutes a binding agreement between the Buyer (Clínica Ortodóntica Los Palos Grandes, C.A.) and the Supplier (OrthoSupply International, S.A. de C.V.) for the procurement of orthodontic supplies, equipment, and professional services intended for use by the Orthodontist team at the Buyer's facility located in Venezuela Caracas.
  2. All items listed in Section 3 must meet or exceed the quality standards established by the Venezuelan Ministry of Health (Ministerio del Poder Popular para la Salud) and the International Organization for Standardization (ISO 13485 for medical devices).
  3. Delivery shall be made DDP (Delivered Duty Paid) to the Buyer's address in Venezuela Caracas, Los Palos Grandes district. The Supplier is responsible for all customs clearance, import documentation, and regulatory compliance required by Venezuelan authorities (SENIAT, ADUANAS) prior to final delivery.
  4. The Orthodontist team at the receiving clinic will inspect all goods upon arrival. Any discrepancies, damaged items, or non-conforming products must be reported within five (5) business days of delivery. The Supplier shall replace or credit non-conforming items within ten (10) business days of notification.
  5. Payment shall be made via international wire transfer (SWIFT) to the Supplier's designated bank account within thirty (30) calendar days from the date of confirmed delivery and acceptance of goods in Venezuela Caracas. Late payments shall accrue interest at a rate of 1.5% per month.
  6. The Supplier warrants that all orthodontic products are new, unused, and manufactured within the last twelve (12) months. The intraoral scanner (Item 006) carries a two-year manufacturer's warranty with on-site service coverage in Venezuela Caracas.
  7. This Purchase Order is governed by the laws of the Republic of Venezuela. Any disputes arising from this agreement shall be resolved through arbitration in Venezuela Caracas in accordance with the rules of the Venezuelan Chamber of Commerce.
  8. The Supplier acknowledges that the purchased goods are intended exclusively for professional use by a licensed Orthodontist and associated dental team in a registered clinical facility in Venezuela Caracas. Resale or redistribution is prohibited without prior written consent.
  9. Force majeure events, including but not limited to natural disasters, government sanctions, or port closures affecting the Port of La Guaira or the Port of Puerto Cabello, shall extend delivery timelines proportionally without penalty to either party.
  10. All communications regarding this Purchase Order shall be directed to the contact persons listed in Sections 1 and 2. Amendments to this document must be made in writing and signed by both parties.
5. DELIVERY & LOGISTICS NOTES

Goods shall be shipped via air freight from Guadalajara, México, to the Simón Bolívar International Airport (CCS) in Venezuela Caracas. The Supplier's appointed freight forwarder (DHL Global Forwarding) will handle all logistics. The Buyer's receiving agent, Dr. María Fernanda Rojas, will be available at the clinic's receiving dock between 08:00 and 16:00 on the scheduled delivery date. All orthodontic supplies must be stored in climate-controlled packaging (15°C–25°C) during transit to ensure product integrity for the Orthodontist clinical team.

Authorized by (Buyer):

Dr. María Fernanda Rojas
Lead Orthodontist / Clinic Director
Clínica Ortodóntica Los Palos Grandes, C.A.
Venezuela Caracas
Date: _______________

Accepted by (Supplier):

Lic. Carlos Mendoza
Regional Sales Director
OrthoSupply International, S.A. de C.V.
Guadalajara, México
Date: _______________

This Purchase Order (PO-VC-2025-0847) was generated for the procurement of Orthodontist professional supplies and equipment for use in Venezuela Caracas. This document is valid for a period of sixty (60) days from the date of issue. Unauthorized reproduction or modification of this Purchase Order is strictly prohibited. For inquiries, contact the Buyer's procurement department at [email protected].

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