Bill To:


Amax Auto Insurance
3030 N. stemmons Freeway, Suite B
Dallas, TX 75247

Services Rendered To:


Lee Charles
6044 Sundown Drive
Fort Worth, Texas 76114
Policy # 142-55053-7161-001


Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12334 FM 730 North - Azle, Texas

Subtotal $700.00
Total Due $700.00


Updated
November 12, 2021 @ 4:01 pm

Invoice updated by Geoffrey.

Status Update
November 12, 2021 @ 4:01 pm

Status changed: Draft to Pending.