GovPayNet - The Simple Way To Pay

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PLC:

a0048z

Agency:

camarillo health care district

For:

client payments

Phone:

805-388-1952 x100

Address:

3639 east las posas road,suite 117
camarillo, california 93010

*Required Field

Payment Information

If you are making an Anonymous Donation, please use abc123 St. as your Address and all Zeros for your Phone Number. Then select DONATION from the Payment Type Drop-down. Thank you.

*Client Name/Donor Name:

Middle:

*Last:

*Address:

*City:

*State:

*Zip:

*Phone Number:

(### - ### - ####)

E-mail Address:

*Payment Type:

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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