Bill To:


Destani Durrett
115421 S. 4257 Road
Checotah, OK 74426

Services Rendered To:


Destani Durrett
115421 S. 4257 Road
Checotah, OK 74426


*** 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)

    $250.00
    1.75
    $437.50
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.75
    $437.50
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.75
    $437.50
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1060 Road - .5 Miles West of Highway 266 - Checotah, OK

Subtotal $1,562.50
Total Due $1,562.50


Updated
May 16, 2021 @ 5:48 pm

Invoice updated by Geoffrey.

Status Update
May 16, 2021 @ 5:48 pm

Status changed: Draft to Pending.

Updated
May 16, 2021 @ 5:49 pm

Invoice updated by Geoffrey.

Updated
October 4, 2021 @ 8:22 pm

Invoice updated by Geoffrey.

Updated
October 4, 2021 @ 8:24 pm

Invoice updated by Geoffrey.

Updated
June 12, 2022 @ 4:36 pm

Invoice updated by Karen Smith.