Bill To:


Brandi Stovall
1219 Locust Street
Malvern, AR 72104

Services Rendered To:


Brandi Stovall
1219 Locust Street
Malvern, Arkansas 72104

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-015-20-1911-E 11/19/2020 07/13/2021 On Receipt Tiger Mountain Fire Department

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Product
Price
Qty
Amount
  1. 405 Medical Extrication – Lvl 1

    Patient:

    Brandi Stovall

    1219 Locust Street

    Malvern, Arkansas 72104

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 Eastbound @ MM 247 - Henryetta, Oklahoma

Subtotal $500.00
Total Due $500.00


Updated
July 12, 2021 @ 4:22 pm

Invoice updated by Geoffrey.

Updated
August 25, 2021 @ 4:25 pm

Invoice updated by Geoffrey.

Updated
August 25, 2021 @ 4:26 pm

Invoice updated by Geoffrey.

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