Bill To:

KENTUCKY FARM BUREAU MUTUAL
9201 BUNSEN PARKWAY
LOUISVILLE, KY 40220-3792

Services Rendered To:

Kelli Claypool
200 Showgait Lane
Columbia, KY 42728
Policy # 002003829


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient;

    Kelli Claypool
    200 Showgait Lane
    Columbia, KY 42728
    Policy # 002003829

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 169 Chestnut Grove Road - Columbia, Kentucky

Subtotal $1,500.00
Total Due $1,500.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
October 12, 2021 @ 2:14 pm

Invoice updated by Geoffrey.