Bill To:


Direct Auto Insurance Claims Department
PO Box 1623
Winston Salem, NC 27102

Services Rendered To:


Sienna Wilson
4540 Colburn Mtn Rd
Russellville, AL 35654
POLICY# 2016788386

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-02-006-22-348 12/11/2022 12/13/2022 On Receipt Littleville VFD

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

    $350.00
    1
    $350.00
  2. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 205 Foam (Per Gallon)

    $65.00
    5
    $325.00
  5. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 4540 Colburn Mtn Rd- Russellville, AL

Subtotal $1,150.00
Total Due $1,150.00


Updated
December 13, 2022 @ 12:33 pm

Invoice updated by Geoffrey.

Status Update
December 13, 2022 @ 12:33 pm

Status changed: Draft to Pending.