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Welcome to Morton Hospital and Medical Center Online Payment Center. |
For your convenience please fill out the payment form below. All information will be kept secure and confidential. For more information you may call our business office during working hours. |
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Name of Patient Name of patient treated. |
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Invoice number (optional) Invoice number. (Should be located on your bill, this is optional.) |
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Name of Payor Payor's name on credit card. |
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Billing Address Address where your credit card 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 email 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 Discover American Express |
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Credit card number Input the 16 digit number just as it appears on the card. |
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Credit card expiration date Example: 00/00 |
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Comments Or Messages Related To Your Payment |
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