Pay - Eaton Rapids Medical Center

Step 1. Account Number & Payment Amount
Account #*
Payment Amount*

Example: 75.00
Step 2. Payment Information
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Billing address must match credit card address on record.
Full Name
First Last
Address*
Street Address City State ZIP Code
Email*

We require an Email address in order to send a receipt.
Phone*
Do not hit the submit button more than once, as your card may be processed multiple times.
Comments
This field is for validation purposes and should be left unchanged.

Step 1. Account Number & Payment Amount