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Invoice
4111161
VERTEX) aRx;Inc.EM[O•'•W10865000
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Jamie Heckman
City of Fort Collins
IT Department - 3rd Floor
215 N Mason St
Fort Collins CO 80524
Payroll Tax O Series Solution Service Agreement:l:Paymll Tax O Series
Solution:01-OCT-2014:30-SEP-2015:
Approved
,ir.3ar / Supplier
OV # Batch #
_ r
PV # Batch #
Acct. #
Jamie Heckman
City of Fort Colllns
IT Department - 3rd Floor
215 N Mason St
Fort Collins CO 80524
FFP
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6.780.00
Special Instructions:
SUBTOTAL
TAX
TOTAL (USD)
6,780.00
0.00
6,780.00
Amounts fisted above include all applicable price adjustments.
To avoid any Interruption In service, please remit your check payable In U.S. funds to Vertax Inc. to the Remittance address above. If you wish to pay by
Credit Card, please log In to my.vertexine.com, dick the My Profile link, select the Open Invoices tab and invoice Numbers you would Oka to pay. Then
click the Pay Selected Invoices button. To pay by ACH, Wire or Overnight Payment, please see the reverse side.
Check here _ if your address has changed. Enter all address changes on the reverse side and fax to the CIM Group at (001) 610-407.9421.
Any questions or comments about this Invoice, contact VeReies Accounts Receivable Group by telephone at
800-3553500 or 48"OS-5832, or by fax at 61 0-107A594 or by email at accounts.receiyabl@Overtexinc.com.
1041 Old Cassatt Road • Berwyn, PA 19312 • T: 610.640.4200 • F: 610.640.5892 • vertexinc.com
Fed Id: 23-2081753 • Canada Business Number. 845021286RT000I • Quebec Registration #1218401003