Bill To:

Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:

Emily Hemenway
520 CR 121
Gainesville, TX 76240
POLICY# 23242711


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Emily Hemenway
    520 CR 121
    Gainesville, TX 76240
    POLICY# 23242711

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1765 FM 2896- 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 19, 2023 @ 4:08 pm

Invoice updated by Geoffrey.