Bill To:


Southern County Mutual Insurance Co.
PO Box 809076
Dallas, TX 75380-9076

Services Rendered To:


Alice Hemperley
Policy# 46 ETX 359594510078


Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $350.00
    2
    $700.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    2
    $600.00
  3. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  4. 409 Manpower (Per Hour)

    $20.00
    8
    $160.00

  5. Additional Incident Info

    Incident Type: Select One

    Incident Location: 9808 TX HWY 77 West, Cass County

Subtotal $1,505.00
Total Due $1,505.00
Updated
August 25, 2019 @ 12:36 am

Invoice updated by Karen Smith.

Status Update
August 25, 2019 @ 12:36 am

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 3:31 pm

Invoice viewed by 64.124.8.25 for the first time.