Bill To:


ALLSTATE PIP / MED PAY
PO BOX 2874
CLINTON, IA 52733-2874

Services Rendered To:


David Alford
677 Oak Grove Road
Westville, Florida 32464
Policy # 9719739731027

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
FL-51-061-2021-39-E 03/25/2021 04/01/2021 On Receipt Ponce De Leon Fire and Rescue

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

    Patient:

    David Alford
    677 Oak Grove Road
    Westville, Florida 32464

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: Select One

    Incident Location: 677 Oak Grove Road Westville, Florida 32464

Subtotal $1,500.00
Total Due $1,500.00


Updated
March 31, 2021 @ 6:41 pm

Invoice updated by Geoffrey.

Updated
March 31, 2021 @ 6:42 pm

Invoice updated by Geoffrey.

Updated
September 22, 2021 @ 2:56 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2023 @ 3:29 am

Invoice viewed by 174.114.106.157 for the first time.