Bill To:

GERMANIA INSURANCE COMPANY
507 Hwy. 290 E
Brenham, TX 77833

Services Rendered To:

Annette Wooten
114 Courtney Ln
Callisburg, TX 76240
POLICY# 2302211027945


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Annette Wooten
    114 Courtney Ln
    Callisburg, TX 76240
    POLICY# 2302211027945

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Fm 2896 & Blankship Hill Lane- Gainesville, TX

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
January 11, 2023 @ 2:44 pm

Invoice updated by Geoffrey.