Bill To:


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

Services Rendered To:


Cynthia Edwards
11300 Highway 271
Tyler, Texas 75708
POLICY # 45327290

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-309-22-53-E 04/30/2022 05/17/2022 On Receipt Zavalla Fire Department

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

    PATIENT:

    Cynthia Edwards
    11300 Highway 271
    Tyler, Texas 75708
    POLICY # 45327290

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 69 Southbound @ Deadman's Road - Zavalla, Texas

Subtotal $1,500.00
Total Due $1,500.00


Updated
May 16, 2022 @ 4:56 pm

Invoice updated by Geoffrey.

Updated
May 16, 2022 @ 4:56 pm

Invoice updated by Geoffrey.

Updated
June 14, 2022 @ 12:54 pm

Invoice updated by Geoffrey.

Updated
June 14, 2022 @ 12:55 pm

Invoice updated by Geoffrey.

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