Bill To:

Acuity A Mutual Insurance
2800 S. Taylor Drive
Sheboygan, WI 53081

Services Rendered To:

Sealy Concrete Inc.
4460 NE Interstate 10 (Frontage RD)
Sealy, TX 77474
Driver: Wayne Walger
POLICY # ZC7442


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Wayne Walger

    406 S. 3rd Street

    Wallis, TX 77485

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 9300 Block of FM 1458 & Ward Bend - San Felipe, 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
July 20, 2022 @ 6:02 pm

Invoice updated by Geoffrey.