Bill To:


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

Services Rendered To:


Ross Parker
14194 FM 315 N
Chandler, TX 75763
POLICY# 6105227687

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-208-22-130-E 10/28/2022 10/31/2022 On Receipt Van Zandt Midway VFD

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

    PATIENT

    Ross Parker
    14194 FM 315 N
    Chandler, TX 75763
    POLICY# 6105227687

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Fm 279 @ Van Zandt / Smith Co. Line- Tyler, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
October 31, 2022 @ 1:04 pm

Invoice updated by Geoffrey.