Bill To:

NATIONAL GENERAL INSURANCE
PO BOX 3199
WINSTON SALEM, NC 27102-3199

Services Rendered To:

Franklin Thomas
13696 Highway East
Eldridge, MO 65463
POLICY# 2014561697


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Franklin Thomas
    13696 Highway East
    Eldridge, MO 65463
    POLICY# 2014561697

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway East and North 5 - Eldridge, MO

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
April 25, 2022 @ 1:13 pm

Invoice updated by Geoffrey.