Bill To:


GREAT WEST CASUALTY
1100 WEST 29th STREET
SOUTH SOUIX CITY, NE 68776-3130

Services Rendered To:


J & J Express
P.O. Box 30983
Memphis, AR 38130
Driver: Robert Warren
POLICY # MCP32868A


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

    $350.00
    1
    $350.00

  2. Additional Incident Info

    Incident Type: Fire Department Response

    Incident Location: I-40 Westbound @ MM 247 - Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $350.00
Total Due $350.00


Updated
July 25, 2022 @ 7:05 pm

Invoice updated by Geoffrey.

Status Update
July 25, 2022 @ 7:05 pm

Status changed: Draft to Pending.

Updated
August 12, 2022 @ 6:03 pm

Invoice updated by Geoffrey.