Bill To:

Progressive Insurance – Medical
P.O. Box 2930
Clinton, IA 52733-2930

Services Rendered To:

Shanda Ince
146 Meadow Path
New Braunfels, TX 78130
Policy # 936596378


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    Patient:

    Shanda Ince
    146 Meadow Path
    New Braunfels, TX 78130
    Policy # 936596378

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 5200 Block of FM 725 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution NO. 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
August 8, 2021 @ 5:14 pm

Invoice updated by Geoffrey.

Updated
September 13, 2021 @ 4:34 pm

Invoice updated by Geoffrey.