Bill To:

Old American County Mutual
P.O. Box 793747
Dallas, TX 75379-3747

Services Rendered To:

Deirdre Rhodes
1557 Nash Road
Lufkin, Texas 75901
Policy # TEJ01721816-02


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Deirdre Rhodes
    1557 Nash Road
    Lufkin, Texas 75901
    Policy # TEJ01721816-02

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 1270 at Saron Road - Zavalla, 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
March 4, 2021 @ 3:11 pm

Invoice updated by Geoffrey.