Bill To:


Home State County Mutual Insurance
P.O. Box 8036
Waco, TX 76714-8036

Services Rendered To:


Michael Sleeman
33435 Howell Rd
Waller, TX 77484
POLICY# 1000268188


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

    Patient

    Michael Sleeman
    33435 Howell Rd
    Waller, TX 77484
    POLICY# 1000268188

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 59- Woodlawn, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
January 11, 2024 @ 12:44 pm

Invoice updated by Geoffrey.