Bill To:

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

Services Rendered To:

Andrew Kerley
1850 Chapman Rd
GoodWater, AL 35072
POLICY# 5713429-B07-01


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    Patient

    Lilly Adams
    1850 Chapman Rd
    GoodWater, AL 35072

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 72757 Hwy 9- Ashland, AL

Subtotal $500.00
Total Due $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 15, 2023 @ 11:30 am

Invoice updated by Geoffrey.