Bill To:


Jamie Ramos
1703 MorningSide Dr
Gainesville, TX 76240

Services Rendered To:


Jamie Ramos
1703 MorningSide Dr
Gainesville, TX 76240
POLICY# 485 8552-G15-43 001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-464039-E 07/30/2022 03/17/2023 On Receipt Callisburg VFD

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

    Patient

    Jamie Ramos
    1703 MorningSide Dr
    Gainesville, TX 76240
    POLICY# 485 8552-G15-43 001

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: CR 163 & US Hwy 82- Gainesville, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
January 23, 2023 @ 11:33 am

Invoice updated by Geoffrey.

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February 1, 2023 @ 11:28 pm

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Updated
March 17, 2023 @ 3:25 pm

Invoice updated by Sherryf.

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