Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Justin & Thersa Fowler
216 County Rd 111
Whitesboro, TX 76273
POLICY# 3714894

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-472460 11/19/2022 12/06/2022 On Receipt Callisburg VFD

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 678 & Big Indian Rd- Callisburg, TX

Subtotal $400.00
Total Due $400.00


Updated
December 6, 2022 @ 4:30 pm

Invoice updated by Geoffrey.

Status Update
December 6, 2022 @ 4:30 pm

Status changed: Draft to Pending.