Carbon County Ambulance
             
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:
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Phone:
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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)
(4% for foreign cards)
eCheck (ACH): $0.75
Method of Payment:
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