AGENCY BILL - Western National Insurance Group
AGENCY BILL - Western National Insurance Group
AGENCY BILL - Western National Insurance Group
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MonthAgency NumberAdjustmentsPolicy NumberAgency NameReason foradjustmentStatementAmount 250.00Amount asshown onstatementAdjustment tostatement balanceCP xxxxxxxxxxx Policy being cancelled 115.00 (115.00)WC xxxxxxxxxxDid not pay originalon 07/03 (27.00) 27.00Adjustment Total 115.00Total Paid 162.00<strong>Western</strong> <strong>National</strong> <strong>Insurance</strong> <strong>Group</strong> AG-4 February 2010
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