Bill To:


Progressive Insurance – Medical
P.O. Box 2930
Clinton, IA 52733-2930

Services Rendered To:


Christopher Charles
10510 Trey Road
Needville, Texas 77461
Policy # 953104361

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-GS-417-21-184-E 11/24/2021 12/17/2021 On Receipt Fairchild V.F.D.

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

    Patient:

    Christopher Charles
    10510 Trey Road
    Needville, Texas 77461
    Policy # 953104361

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 361 & Needville Fairchild Road - Fairchild, Texas

Subtotal $1,500.00
Total Due $1,500.00


Updated
December 16, 2021 @ 10:41 pm

Invoice updated by Geoffrey.

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