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Welcome to Dale Medical Center Online Payment Center. You may pay your hospital bills here by credit/debit card. |
For your convenience please fill out the below payment form. All information will be kept secure and confidential. For more information you may call our business office between 7:30 am and 4:30 pm at 334-774-2601 ext 1314 or 2708.
You may make payments to Dale Medical Center using your credit card information. All payments are via secure server. Thank you for allowing us to serve you. |
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Name Of Patient
Name of Patient Treated. |
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Account Number
Located on your bill. |
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Name of Payor
Payor's Name on Credit Card or Checking Account. |
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Billing Address
Address Where Your Credit Card or Bank Account Statements Are Mailed. |
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City, State, Zip
Please Include Your City, State, and Five Digit Zip Code. |
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Your E-Mail Address
Please Provide An E-mail Address. |
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Amount of Your Payment
Please Specify How Much You Are Paying. Please Use Dollars and Cents. |
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Credit Card Type
Select If You Are Paying By Credit Card. |
Visa MasterCard |
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Credit Card Number
Input The 16 Digit Number Just As It Appears On Card. |
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Credit Card Expiration Date
Example: 00/00 |
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CV3 Code
3 digit number on the back of your card. |
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Comments Or Messages Related To Your Payment |
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