Bill To:


American Health Insurance
8000 Norman Center Drive, Ste. 1200
Minneapolis, MN 55437

Services Rendered To:


Susan Bailey
4020 S. Catfish
Newalla, OK 74857
Policy/Acct# 1000575241

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-55-024-22-128 06/06/2022 06/27/2022 On Receipt Newalla Fire Department

Product
Price
Qty
Amount
  1. 410 Fire Department Response Fee – Lvl 1

    $200.00
    1
    $200.00

  2. Additional Incident Info

    Incident Type: Fire Department Response

    Incident Location: 4020 S. Catfish Newalla, OK 74857

Subtotal $200.00
Total Due $200.00


Updated
June 27, 2022 @ 1:44 pm

Invoice updated by Geoffrey.

Status Update
June 27, 2022 @ 1:44 pm

Status changed: Draft to Pending.

Updated
June 27, 2022 @ 1:44 pm

Invoice updated by Geoffrey.

Updated
August 17, 2022 @ 7:11 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2022 @ 5:51 pm

Invoice viewed by 64.124.8.36 for the first time.