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Welcome to Monroe County Hospital Online Payment Center. You may make payments on your hospital bills here by credit 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 at (478) 994-2521 Monday thru Friday between 8:00 a.m. and 5:00 p.m.
You may make payments to Monroe County Hospital using your credit card information in the designated fields. 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 Account number. (Should be located on your statement) |
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Name of Payor Payor's name as it appears on credit card |
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Billing Address Address where your credit card statement is 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 a valid e-mail address. |
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Amount of Your Payment Please specify how much you are paying. Please use dollars and cents (eg. 00.00) |
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Credit Card Type Select type of credit card |
Visa MasterCard Discover |
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Credit Card Number Enter the 16 digit number just as it appears on card |
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Credit Card Expiration Date Enter credit card expiration in MMYY format (Example: 0106) |
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Comments Or Messages Related To Your Payment |
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