Bill To:

Matonna Haynes
31657 Johnson Road
Muad, OK 74854

Services Rendered To:

Matonna Haynes
31657 Johnson Road
Muad, OK 74854


*** Please Submit this to your PROPERTY/HOMEOWNER Insurance Company for processing and payment OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

Product
Price
Qty
Amount

  1. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  2. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

    3. Additional Incident Info

    Incident Type: Fire Department Response

    Incident Location: 20450 Southeast 29th Street - Harrah, OK

Subtotal $275.00
Total Due $275.00


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 6, 2022 @ 6:16 pm

Invoice updated by Geoffrey.

Status Update
April 6, 2022 @ 6:16 pm

Status changed: Draft to Pending.