Bill To:

Loya Insurance Company
P.O. Box 972450
El Paso, TX 79997

Services Rendered To:

Randy Lemmon
Shauna Dr
Ft Worth, TX 76130
POLICY# 788-6862828


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    Patient

    Brandy Lemmon
    4601 Jolly Ct
    Ft Worth, TX 76135

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 E MM 246- Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

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
November 7, 2023 @ 7:56 am

Invoice updated by Geoffrey.