Bill To:


ALLSTATE INSURANCE
3075 SANDERS ROAD - SUITE H1A
NORTHBROOK, IL 60062-7127

Services Rendered To:


Jenna Cantu
12730 Mykawa Rd
Pearland, TX 77581
POLICY# 436176130


Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Jenna Cantu
    12730 Mykawa Rd
    Pearland, TX 77581
    POLICY# 436176130

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 222 IH 45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,500.00
Total Due $1,500.00


Updated
October 4, 2023 @ 11:45 am

Invoice updated by Geoffrey.

Updated
October 16, 2023 @ 6:06 pm

Invoice updated by Geoffrey.