Orden De Compra (remision)

Medtronic Latin America Product Requisition Form 3850 Victoria St. N. MS-V310 Shoreview, MN 55126 Contact: Shauna Stephens Tel: 763-514-8084 Fax: 763-514-8089

X Air Shipment Method: Truck Freight Forwarder/Courier: Superior Freight Service Inc Address: 2600 East 81 Street Bloomington, MN 55425 Tel: (952) 854 5053 Fax: (952) 646 0893 Contact Person: Charlie Jakala

Customer: Address:

Selecciones Medicas S.A. de C.V. Sinaloa #85 Col. Roma C.P. 06700, Mexico D.F. Tel: (52) 55 50 80 15 00 Fax: (52) 55 50 80 15 48 Contact Person: Purchase Order#: Incoterms:

CPT

CIF

Import License#:

CIP

X EXW

Quality Certificate:

Cotecna/SGS inspection#:

Special Instructions:

Ship to consignee: Fernandez Hinojosa y Cia S.C. Soles 56 Col. Peñon de los Banos, C.P. 15520, Mexico D.F.

Cliente QTY MODEL

X

DESCRIPTION

SSA

Date:

HS CODE

Sterilization Certificate:

sition Form

9

X Air od: Truck er/Courier: Superior Freight Service Inc. 2600 East 81 Street Bloomington, MN 55425 854 5053 646 0893 : Charlie Jakala

te:

X

Sterilization Certificate:

xico D.F.

UNIT PRICE

AMOUNT

EA PK

Orden de Compra 11341 11341

IMSS 21 May 07 ISSSTE

Orden de Compra QTY 11341 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 20 Ea 11341 20 EA 20 EA 20 EA 20 EA 20 EA 20 EA 20 EA 20 EA 20 EA 20 EA 20 EA 20 EA

Pres

Modelo

Descripcion

sd303 sd303 sd303 sd303 sd303 sd303 sd303 sd303 sd303 sd303 sd303 sd303 sd303 sd303

A A A A A A A A A A A A A A

A A A A A A A A A A A A A A

ss ss ss ss ss ss ss ss ss ss ss ss

ss ss ss ss ss ss ss ss ss ss ss ss

ss ss ss ss ss ss ss ss ss ss ss ss

SSA A A A A A A A A A A A A A A ss ss ss ss ss ss ss ss ss ss ss ss

Unit Price

HS Code A A A A A A A A A A A A A A

A A A A A A A A A A A A A A 150 150 150 150 150 150 150 150 150 150 150 150

$1,501.00 $1,501.00 $1,501.00 $1,501.00 $1,501.00 $1,501.00 $1,501.00 $1,501.00 $1,501.00 $1,501.00 $1,501.00 $1,501.00

Amount