This site requires Javascript be enabled.
To continue, please enable Javascript by following instructions specific to the browser you are using.
Carbon County Ambulance Services
Account Information
Patient's Name
Payment Amount:
$
Item Subtotal:
$0.00
Total:
$0.00
Personal Information:
First Name:
Last Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Please be aware that card payments will be described as
HealthSV 800-764-0844 Clinton UT
Payment Information:
Processing Fee Rates:
Cards:
2.5% ($1.50 min)
(1.5% surcharge for foreign cards)
eCheck:
$0.75
Method of Payment:
Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
Submitting ...
Cancel
SIP
Program & Data © 2006-2021
Instant Payments
All rights reserved.
~
Terms & Conditions
~
Privacy Policy
~
Contact Us
~
SIP Version 3.07.14803; (API: 2.18)
