Bill To:

American Family Connect Property and Casualty
3500 Packerland Drive
Depere, WI 54115

Services Rendered To:

Jayden Christman
19697 Houston Road
Lebanon, MO 63556
Policy # 796910691


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Jayden Christman
    19697 Houston Road
    Lebanon, MO 63556
    Policy # 796910691

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 17098 Highway East - Eldridge, MO

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 17, 2021 @ 4:49 pm

Invoice updated by Geoffrey.

Updated
August 25, 2021 @ 3:56 pm

Invoice updated by Geoffrey.

Updated
October 21, 2021 @ 3:15 pm

Invoice updated by Geoffrey.

Updated
October 21, 2021 @ 3:29 pm

Invoice updated by Geoffrey.