Bill To:

ALLSTATE PIP / MED PAY
PO BOX 2874
CLINTON, IA 52733-2874

Services Rendered To:

Suzanne Holloway
620 West FM 6
Nevada, Texas 75173
Policy # 000000416292283


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Judy Holloway
    620 West FM 6
    Nevada, Texas 75173

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 78 & Lake Road - Lavon, Texas

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
May 17, 2021 @ 6:56 pm

Invoice updated by Geoffrey.