Bill To:


Matonna Haynes
31657 Johnson Road
Muad, OK 74854

Services Rendered To:


Matonna Haynes
31657 Johnson Road
Muad, OK 74854


*** Please Submit this to your PROPERTY/HOMEOWNER Insurance Company for processing and payment OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

Product
Price
Qty
Amount
  1. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  2. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  3. Additional Incident Info

    Incident Type: Fire Department Response

    Incident Location: 20450 Southeast 29th Street - Harrah, OK

Subtotal $275.00
Total Due $275.00


Updated
April 6, 2022 @ 6:16 pm

Invoice updated by Geoffrey.

Status Update
April 6, 2022 @ 6:16 pm

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 7:26 am

Invoice viewed by 64.124.8.25 for the first time.