Bill To:

Progressive Insurance
6300 Wilson Mills Rd.
Mayfield, OH 44143

Services Rendered To:

Jolinda Bell
3000 North Hiwassee
Choctaw, OK 73020
Policy # 928727636


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $500.00
    1.5
    $750.00

  2. 206 Latex Gloves (Pairs Used)

    $2.00
    1
    $2.00

  3. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    1
    $50.00

    4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 West Bound @ MM 255 - Choctaw, OK

Subtotal $802.00
Total Due $802.00

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
December 26, 2020 @ 6:42 pm

Invoice updated by Geoffrey.

Status Update
December 26, 2020 @ 6:42 pm

Status changed: Draft to Pending.

Updated
December 26, 2020 @ 6:45 pm

Invoice updated by Geoffrey.