Pay Online

Please note that some of our agencies charge a convenience fee of 3% for all credit card payments.

If you are using this to make a donation to your choice of agency, Please write down "Donation to XXX Ambulance" so we can apply the funds to the correct agency and no processing fee's will be assessed.

Patient Information

First Name*

Last Name*

Phone Number*

Email Address

Billing Information

First Name*

Last Name*

Billing Address*

Order Information

Account # or Claim #*

Amount to Pay*

Credit Card Number*

Expiration Date

CVV Code

By checking this box,

You agree to pay the listed amount plus a maximum of 3% convenience fee fees. Logical Billing Solutions, Inc does not retain your credit card information for future payments and that each payment can incur processing fees.

If you would like to find out more information if your agency charges a fee or not, please contact one of our representatives at 585-563-1112 Mon-Fir 9-5.

I agree with the terms & conditions above