Bill To:

USAA INSURANCE – MEDICAL CLAIMS
PO BOX 5000
DAPHNE, AL 36526-5000

Services Rendered To:

Michael Blankenship
689 Gallagher Road
McQueeney, Texas 78123
Policy # 013748870V71036


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    Patient:

    Glenwood Warncke
    338 Spyglass
    McQueeney, TX 78123
    Policy # PA206933204

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6000 Block of FM 725 - McQueeney, Texas

    Ordinance Info: RESOLUTION-McQueeney Cost Recovery Resolution 4521

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
January 18, 2022 @ 5:50 pm

Invoice updated by Geoffrey.