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v <br />Purchase Order Form <br />Account Manager <br />Cell Phone <br />Check box if Billing same as Shipping <br />BILI TO CUSTOMER M <br />Billing Account Num 1074328 <br />Company Name <br />Contact or Department <br />Street Address _ <br />Addt'I Address Line _ <br />City, ST ZIP <br />Phone <br />Authorized Customer Initials <br />Purchase Order Date <br />Expected Delivery Date <br />Stryker Quote Number <br />stryker <br />221216093826 <br />SHW 7O <br />Shipping Account Num <br />CUSTOMER N <br />1074328_ <br />Company Name <br />Mayfield Village Fire Department <br />Contact or Department <br />Gino Carcioppolo <br />Street Address — <br />770 S.O.M. Center Road ~~ — <br />Addt'I Address Line <br />City, ST ZIP <br />Phone <br />Mayfield Village, OH 44143 <br />(440)461-1208 <br />Authorized Customer Initials <br />DESCRIPTION QTY TOTAL <br />REFERENCE QUOTE O <br />Accounts Payable Contact Information <br />CW Name <br />Email <br />Phone <br />Stryker Terms and Conditions <br />h ttos: //techweb-stryker. corn <br />Authorized Customer Signature <br />Printed Name BRENDA BODNAR <br />STEPHEN SCHUTT <br />Title MAYOR <br />RE <br />Signature <br />Signature: �--- <br />Date <br />Attachment Stryker Quote Number <br />221216093826 <br />'Sales or use taxes on domestic (USA) deliveries will be invoiced in addition to the price of the goods and services on the Stryker Quote. <br />