Bill To:


Jasmine Flowers
6589 Joel Perez Place
Fort Sill, OK 73503

Services Rendered To:


Jasmine Flowers
6589 Joel Perez PL.
Fort Sill, OK 73503
Policy # 0175018507104


*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Interstate 40 @ MM 253 - Checotah, OK

Subtotal $900.00
Total Due $900.00


Updated
March 16, 2021 @ 1:23 pm

Invoice updated by Geoffrey.

Status Update
March 16, 2021 @ 1:23 pm

Status changed: Draft to Pending.

Updated
October 4, 2021 @ 2:09 pm

Invoice updated by Geoffrey.