Bill To:


SHOA Logistics LLC
4104 SH-349
Midland, TX 79706

Services Rendered To:


Terry Vaught Jr
564 Private Rd 3526
Kilgore, TX 75604
POLICY# 642427113

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-501-23-104-E 01/04/2023 10/10/2023 On Receipt Moffett VFD

Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Kody Hall

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Crain Rd & US Hwy 103 E- Lufkin, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
October 10, 2023 @ 10:27 am

Invoice updated by Geoffrey.

Updated
October 18, 2023 @ 10:53 am

Invoice updated by Geoffrey.