Bill To:

Farmer's Insurance
PO Box 0991
Carol Stream, IL 60132-0991

Services Rendered To:

Raeann Crank
2082 S Hwy 48
Terlton, OK 74081
POLICY# A7997748060


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Scotty Kelley
    10615 E 100 PL
    Tulsa, OK 74133

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 370468 E 5605 Rd- Terlton, OK

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 14, 2023 @ 12:41 pm

Invoice updated by Geoffrey.