Bill To:

SOUTHWESTERN INSURANCE SERVICES
4375 Palm Avenue
Hialeah, FL 33012

Services Rendered To:

Queens Truck Rental
1426 Banyan Way
Weston, Florida 33327
POLICY# WHI01000000772-0


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    PATIENT

    Henry Montoya
    67 Tortuga Rd
    Palm Springs, Florida 33461

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Int 20 Mile Marker 613 Westbound- Marshall, TX

Subtotal $500.00
Total Due $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 28, 2022 @ 11:02 am

Invoice updated by Geoffrey.

Updated
January 26, 2023 @ 3:00 pm

Invoice updated by Karen Smith.

Updated
January 26, 2023 @ 3:01 pm

Invoice updated by Karen Smith.