Bill To:


GERMANIA INSURANCE COMPANY
507 Hwy. 290 E
Brenham, TX 77833

Services Rendered To:


Annette Wooten
114 Courtney Ln
Callisburg, TX 76240
POLICY# 2302211027945

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-474598-EEE 12/16/2022 01/11/2023 On Receipt Callisburg VFD

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

    Patient

    Jordan Carriker
    1219 Magnolia St
    Gainesville, TX 76240

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Fm 2896 & Blankship Hill Lane- Gainesville, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
January 11, 2023 @ 2:51 pm

Invoice updated by Geoffrey.