Bill To:


American Access Casualty
2211 Butterfield Road, Suite 200
Downers Grove, IL 60515

Services Rendered To:


Ariel Caseras
12536 Zion Rd
Tomball, TX 77375
POLICY# 42AU001043904

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-28345-E 11/04/2023 01/09/2024 On Receipt Angus Vol. Fire Department

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

    Patient

    Ariel Caseras
    12536 Zion Rd
    Tomball, TX 77375
    POLICY# 42AU001043904

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 214 NB IH45- Richland, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,500.00
Total Due $1,500.00


Updated
January 9, 2024 @ 3:49 pm

Invoice updated by Geoffrey.

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