Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Crystal Hartman
423 Private Road 8080
Ben Wheeler, Texas 75754
Policy # 21896031


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

    $350.00
    1
    $350.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 64 @ County Road 4926 - Ben Wheeler, Texas

Subtotal $1,258.00
Total Due $1,258.00
Updated
November 18, 2020 @ 5:07 pm

Invoice updated by Geoffrey.

Status Update
November 18, 2020 @ 5:07 pm

Status changed: Draft to Pending.

Updated
November 18, 2020 @ 5:08 pm

Invoice updated by Geoffrey.

Viewed
October 22, 2022 @ 8:11 am

Invoice viewed by 64.124.8.27 for the first time.