Form Purchase Order

This document is a purchase order from AESCULAPS MEDICAL CENTER (AMC) to CV.Sumifin Karya Mandiri for the supply of two medical analyzers and accessories. The purchase order includes a hematology analyzer for 140,000,000 and an automatic biochemistry analyzer for 270,000,000. The total cost before discounts is 410,000,000 with a 22% discount bringing the total to 319,800,000. The vendor is asked to sign and return the purchase order by fax to confirm the order.

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Form Purchase Order

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aswar123

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AESCULAPS MEDICAL CENTER (AMC)

Jl. Indrakila (Strat 03) No.05 Balikpapan Kalimantan Timur 76125 Telp. 0542 440404/444055, Fax. 0542 - 415366 Vendor : CV.Sumifin Karya Mandiri Jl. Gunung Rejo No.08 Balikpapan Kalimantan Timur Attn : Mr.Rasino

Purchase Order
No. Date : : PO/076/09/2011 10 September 2011

Place of Delivery : Klinik AMC Balikpapan Jl. Indrakila (Strat 03) No.05 Balikpapan Kalimantan Timur

Please supply the following items : No. 1. Description of Goods Hematology Analyzer ( Mindray BC 3000 plus ) - Garansi 1 tahun - UPS (Free) - Printer Epson LX 300 (Free) - Blood Mixer (Free) - Instal dan training analist Automatic Biochemistry Analyzer ( Sclavolab 100 ) - Garansi 1 tahun - UPS (Free) - Printer Epson LX 300 (Free) - Monitor 10 inchi (Free) - Instal dan training analist Unit Unit Quantit y 1.00 Unit Price 140,000,00 0 Amount 140,000,000

Unit

1.00

270,000,00 0

270,000,000

Term of Payment : - DP 30 % - Sisanya dibagi 5x angsuran setiap bulannya. Remarks : - Status reagen alat tersebut : open - Harga sudah termasuk biaya install & training analist.

Sub Total Discount VAT Freight Cost

410,000,000 22% 319,800,000

Total

Ordered by, The PO Number must appear on Delivery Order and Invoice. For the sake of optimal communication, please sign our Purchase Order and return to us by fax on the same day

Prepared by,

Approved by,

Confirmed by,

Dr. Aswar M

Purchasing Staff

Director

Vendor

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Form Purchase Order

Uploaded by

Form Purchase Order

Uploaded by

AESCULAPS MEDICAL CENTER (AMC)

Sub Total Discount VAT Freight Cost

410,000,000 22% 319,800,000

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