Bill To:


Farmer's Insurance
PO Box 0991
Carol Stream, IL 60132-0991

Services Rendered To:


Raeann Crank
2082 S Hwy 48
Terlton, OK 74081
POLICY# A7997748060

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-59-007-23-51-EE 04/21/2023 07/14/2023 On Receipt North 48 Fire Department

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

    Patient

    Scotty Kelley
    10615 E 100 PL
    Tulsa, OK 74133

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 370468 E 5605 Rd- Terlton, OK

Subtotal $1,500.00
Total Due $1,500.00


Updated
July 14, 2023 @ 12:41 pm

Invoice updated by Geoffrey.