Bill To:


STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:


Jennifer Headley
200 Princeton Ln Apt F-1
Jemison, AL 35085
POLICY# 0134169063


Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Reba Headley
    200 Princeton Ln Apt F-1
    Jemison, AL 35085

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US Hwy 31 & Princeton Ln- Jemison, AL

Subtotal $1,500.00
Total Due $1,500.00


Updated
July 12, 2023 @ 12:42 pm

Invoice updated by Geoffrey.