Bill To:


PROGRESSIVE INSURANCE
6300 WILSON MILLS ROAD
MAYFIELD VILLAGE, OH 44143-2109

Services Rendered To:


Perry Gene Banks
604 Shasta St
Dallas, TX 75115
POLICY# 965370235

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-GV-301-24-4068-E 03/18/2024 03/26/2024 On Receipt Dew VFD

Product
Price
Qty
Amount
  1. 405 Medical Extrication – Lvl 1

    Patient

    Latisha Branscumb
    7500 Pinemont Dr
    Houston, TX 77091

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I45 & 193 Mile Post- Teague, TX 75860

Subtotal $500.00
Total Due $500.00


Updated
March 26, 2024 @ 1:45 pm

Invoice updated by Geoffrey.