Bill To:

Amax Auto Insurance
3030 N. stemmons Freeway, Suite B
Dallas, TX 75247

Services Rendered To:

Lee Charles
6044 Sundown Drive
Fort Worth, Texas 76114
Policy # 142-55053-7161-001


Product
Price
Qty
Amount

  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00

  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12334 FM 730 North - Azle, Texas

Subtotal $700.00
Total Due $700.00


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
November 12, 2021 @ 4:01 pm

Invoice updated by Geoffrey.

Status Update
November 12, 2021 @ 4:01 pm

Status changed: Draft to Pending.