Processing Errors
Invalid Card Reader Information
Please click Swipe button or manually key in card details
Service Provider:
River Hills Family Medicine
First Name:
Last Name:
Payment Information
Account Type:
Checking
Saving
Bank Name:
Bank Routing #:
*
*
Name on check:
Check Number:
Account #:
*
*
Card Number:
*
Expiration (MMYY):
*
*
CVV:
../../PayLeapReaders.CAB
Card Verification Code (CVV/CID):
These three or four digit numbers help ensure that the physical card is in the cardholder’s possession while shopping online helping to prevent unauthorized or fraudulent use. The 3-digit code is located on the
BACK
of the card for Visa, MasterCard and Discover. If card type is American Express the code is located above the embossed account number on the
FRONT
of the card.
Card Number:
*
Expiration (MMYY):
*
*
Total Amount:
$0.00