Bill To:

Progressive Insurance – Medical
P.O. Box 2930
Clinton, IA 52733-2930

Services Rendered To:

Antoine Barron
120 Falcon Way, Apt 82
Montevallo, AL 35115
POLICY# 945623169


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Antoine Barron
    120 Falcon Way, Apt 82
    Montevallo, AL 35115
    POLICY# 945623169

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 993 AL Hwy 155- Jemison, 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
June 29, 2023 @ 6:00 pm

Invoice updated by Geoffrey.