Bill To:


Rolando Fereliza
2407 Iroquois Street
Dallas, TX 75212

Services Rendered To:


Rolando Fereliza
2407 Iroquois Street
Dallas, Texas 75212


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

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

    $250.00
    1.75
    $437.50
  2. 102 Engine Response (Per Hour)

    $500.00
    1.75
    $875.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50
  4. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    1
    $50.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US 266 & 1060 Road Checotah, Oklahoma

Subtotal $1,625.00
Total Due $1,625.00


Updated
May 16, 2021 @ 4:14 pm

Invoice updated by Geoffrey.

Status Update
May 16, 2021 @ 4:14 pm

Status changed: Draft to Pending.

Updated
May 16, 2021 @ 4:15 pm

Invoice updated by Geoffrey.

Updated
November 11, 2021 @ 7:35 pm

Invoice updated by Geoffrey.