Bill To:

NATIONAL GENERAL INSURANCE
PO BOX 3199
WINSTON SALEM, NC 27102-3199

Services Rendered To:

Mariano Rico
85 CR 960
Jemison, AL 35085
POLICY# 2013159821


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Pascaul Ruizprez
    65 County Rd 960
    Jemison, AL 35085

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 28530 US Hwy 31- Jemison, 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
November 16, 2023 @ 10:54 am

Invoice updated by Geoffrey.