Bill To:


GEICO INSURANCE – MEDICAL
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


Brandi Love
Policy # 4301-31-36-09

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-2021-392-E 04/23/2021 11/23/2021 On Receipt Briar-Reno Fire Department

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

    Patient:

    Brandi Love
    Policy # 4301-31-36-09

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 730 North @ Reed road - Azle, Texas

Subtotal $1,500.00
Total Due $1,500.00


Updated
November 23, 2021 @ 5:00 pm

Invoice updated by Geoffrey.

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