Bill To:

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

Services Rendered To:

Cryslia Worthy
292 County Road 4678
Boyd, Texas 76023
Policy # 6046517428


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Paydne Downing
    1035 Meadow Oaks
    Azle, Texas 76020

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Portwood Road & FM 730 North - Azle, Texas

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
November 8, 2021 @ 1:45 pm

Invoice updated by Geoffrey.