Bill To:

Georgia Farm Bureau
1620 Bass Road
Macon, GA 31209

Services Rendered To:

Al Gabriel
236 Gassert Road
Newborn, GA 30056
Policy # BAP3209265-10


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Jessica Kiker
    1087 Boozer Road
    Heflin, AL 36264

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 46 Near County Road 42 - Heflin, AL

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
August 23, 2021 @ 4:05 pm

Invoice updated by Geoffrey.