Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Chad Douglas
1253 CR 1455
Mt. Pleasant, TX 75455
Policy # 21914614


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

    Patient:

    Caroline Blackard 
    1253 CR 1455
    Mt. Pleasant, TX 75455
    Policy # 21914614

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Harrold Truck Stop - Vernon, Texas

    Ordinance Info: City of Electra Resolution NO. 2018-05

Subtotal $1,500.00
Total Due $1,500.00


Updated
April 22, 2022 @ 5:50 pm

Invoice updated by Geoffrey.

Updated
April 22, 2022 @ 5:50 pm

Invoice updated by Geoffrey.