Bill To:


Everast Danali Insurance
100 Everest Way
Warren, NJ 07059

Services Rendered To:


CapTech Financial LLC
10679 Hwy 56 East
Sherman, TX 75090
POLICY# EN6CA00266-221


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

    PATIENT

    Brenda Duerer
    3458 LCR 707
    Kosse, TX 76653

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Int of LCR 707 & State Hwy 7 East- Kosse, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
October 31, 2022 @ 12:19 pm

Invoice updated by Geoffrey.