Bill To:

NATIONWIDE INSURANCE – MEDICAL
PO BOX 26005
DAPHNE, AL 36526-5005

Services Rendered To:

Mohammad Eljindi
6308 Windcrest Dr. #2924
Plano, Texas 75024
Policy # 7842J189845


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    Patient:

    Mohammad Eljindi
    6308 Windcrest Dr. #2924
    Plano, Texas 75024
    Policy # 7842J189845

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: MM 217 Northbound on Interstate 45N

    Ordinance Info: City of Angus Billing Authorization Item # 7

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
July 15, 2021 @ 3:12 pm

Invoice updated by Geoffrey.

Updated
July 15, 2021 @ 3:16 pm

Invoice updated by Geoffrey.