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Goods, marking: 

Issued: 
Date of issue: 
USD
12.07.2016
Tel.: +22496xxxx, Fax: , Mail: @lf1.cuni.cz

Instructions for supplier:
QCS-D Quick Connect Dual luered swivel
QCT-12 Male/Male Spring Tether 12"
QCH-21W 21G Quick Connect Harness with separatenon-sterile wire reinforced belly bands and crimp  
connectors 
QC-BB Wire Belly Bands with stainless steel wire 
reinforcement. 
Shipping
37.13
8.76
37.13
10.08
302.78
 8
 20
 30
 20
 1
2 090.52
Total:
 Item
Quantity 
USD
297.04
175.20
1 113.90
201.60
302.78
USD
USD
USD
USD
USD
Unit 
ks
ks
ks
ks
ks
2 090.52
..................................................................
Total preliminary price (without VAT).                                            
Amount 
Stamp, signature

611 Klinika adiktologie
2166110079/ 054         
Order No.:
Contract
:

Customer:
Acc.No.
Bank
Method of payment
:
26.07.2016
Wire Transfer
Date of delivery
:
Univerzita Karlova v Praze 
1.lékařská fakulta 
Kateřinská 32 
121 08 PRAHA 2 
CZECH REPUBLIC 
ID No.:
VAT No.:
00216208
CZ00216208

Date of payment
:
SAI Infusion Technologies
Tel.: +22496xxxx, Fax: , Mail: @lf1.cuni.cz
PID
:

Shipping address:
:
:

Validity of order
:
30.11.2016
Terms of delivery
:

Unit price 
Supplier:

Place of destination
:
Ústav farmakologie 
Univerzita Karlova v Praze 
3. lékařská fakulta 
Ruská 87  
100 00 Praha 10 
Delivery transport
: