Bill To:


Bennett Truck Transport
801 North Second Avenue
Carbon Cliff, IL 61239

Services Rendered To:


Bennett Truck Transport
801 North Second Avenue
Carbon Cliff, IL 61239
Driver: Robert Tennison
Policy # MC285766

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-309-2021-50-E 12/08/2021 12/17/2021 On Receipt Zavalla Fire Department

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

    Patient:

    William Wade
    399 Medford Womack Road
    Zavalla, Texas 75980

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 63 in Front of High School - Zavalla, Texas

Subtotal $1,500.00
Total Due $1,500.00


Updated
December 16, 2021 @ 9:53 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2022 @ 1:25 am

Invoice viewed by 64.124.8.51 for the first time.