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Welcome to the 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 at 970-675-5011 Monday through Friday 7 am to 5 pm.
You may make payments to the Hospital using your credit card information in below
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 - usually in the top left hand corner of your bill. |
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Billing Name Billing 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 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. |
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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 mm/yy |
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CV3 Code |
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Comments Or Messages Related To Your Payment |
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