Bill To:

ALLSTATE PIP / MED PAY
PO BOX 2874
CLINTON, IA 52733-2874

Services Rendered To:

Sargent Marine
100 Clement Road
Sargent, TX 77414
Driver: Jeremy Johnson
Policy # 838-984-463


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Jeremy Johnson
    6918 Perry Court
    Houston, TX 77021
    Policy # 838-984-463

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 8214 FM 457 - Sargent, Texas

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
December 22, 2021 @ 6:09 pm

Invoice updated by Geoffrey.

Updated
December 22, 2021 @ 6:10 pm

Invoice updated by Geoffrey.