Bill To:

Progressive County Mutual Insurance
6300 Wilson Mills Rd.
Mayfield, OH 44143

Services Rendered To:

Dale John
1303 FM 1502
Detroit, TX 75436
POLICY# 950668177


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Dale John
    1303 FM 1502
    Detroit, TX 75436
    POLICY# 950668177

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6700 E Hwy 82- 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 23, 2023 @ 10:53 am

Invoice updated by Geoffrey.