Bill To:

GEICO INSURANCE – MEDICAL
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:

Judy Rose
2061 Lisa Circle
Van, TX 75103
POLICY# 44 999 19 670


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Luis Juarez
    3320 VZ CR 4418
    Canton, TX 75103

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 64 @ CR 4923- Ben Wheeler, 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 2, 2023 @ 11:08 am

Invoice updated by Geoffrey.