Bill To:

Loya Insurance Company
P.O. Box 972450
El Paso, TX 79997

Services Rendered To:

Stormi Wilshire
21115 FM 850
Tyler, Texas 75790
Driver: Jonathan Willis
Policy # 65-383136399


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Stormi Wilshire
    21115 FM 850
    Tyler, Texas 75790

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 42 & Highway 80 - White Oak, Texas

    Ordinance Info: Ordinance 2021-02 Section 30-6

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
June 3, 2021 @ 1:15 pm

Invoice updated by Geoffrey.