Bill To:

STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:

Vehicle Owner
POLICY# 1034455605


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Anthony Davis 

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 43 & Spring Valley Rd- Russellville, AL

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
December 13, 2022 @ 12:21 pm

Invoice updated by Geoffrey.