Bill To:


Integon Insurance
P.O. Box 3199
Winston Salem, NC 27102

Services Rendered To:


Payton Floyd
458 Wright Road
Albertville, AL 35951
Policy # 2011945896


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

    $250.00
    1
    $250.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Denise Circle & Hustleville Road - Albertville, Alabama

Subtotal $866.00
Total Due $866.00


Updated
May 7, 2021 @ 5:26 pm

Invoice updated by Geoffrey.

Status Update
May 7, 2021 @ 5:26 pm

Status changed: Draft to Pending.

Updated
July 15, 2021 @ 6:48 pm

Invoice updated by Geoffrey.

Updated
January 28, 2022 @ 5:44 pm

Invoice updated by Geoffrey.

Viewed
October 24, 2022 @ 6:01 am

Invoice viewed by 64.124.8.42 for the first time.