GovPayNet - The Simple Way To Pay

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PLC:

a004u6

Agency:

lincoln county ems

For:

ambulance/ems payments

Phone:

715-539-1031

Address:

801 north sales street,suite 211
merrill, wisconsin 54452

*Required Field

Payment Information

*Patient Account Name:

Middle:

*Last:

*Patient Account:

Payment Amount

*Payment Type:

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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