Bill To:


NATIONAL GENERAL INSURANCE
PO BOX 3199
WINSTON SALEM, NC 27102-3199

Services Rendered To:


Franklin Thomas
13696 Highway East
Eldridge, MO 65463
POLICY# 2014561697

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-307-22-414-E 04/23/2022 04/25/2022 On Receipt Eldridge V.F.D.

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

    Patient:

    Franklin Thomas
    13696 Highway East
    Eldridge, MO 65463
    POLICY# 2014561697

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway East and North 5 - Eldridge, MO

Subtotal $1,500.00
Total Due $1,500.00


Updated
April 25, 2022 @ 1:13 pm

Invoice updated by Geoffrey.