Step 1: Select Payments
Step 2: Review and Submit
Step 3: Confirmation and Receipt
Step 1: Select Payments

Please complete the form below. When finished, click the Continue button and you will be asked to review the information for accuracy before your payment is processed.

Fees are as follows: E-Checks are a flat rate of $1.50 for any payments under $10,000.00 and $10.00 for anything above. Credit Cards are $1.50 for any payments of $0-$50, $3.00 for payments $50.01 -$100.00 and $3.00 for each additional $100.00.

Note: * indicates a required field.

My Bills
Payment Type: *
Facility Name: *
Facility Address: *
Full Legal Name or Organization: *
Amount: *

Cardholder Information
First Name: *
Last Name: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip Code: *
Phone Number: *
Email Address: *

Payment Information
Payment Method: *
Card Number: * 
Expiration Date: * (in mm/yy format)