Manage Payments - Epimed

Manage Payments

Please select a payment option to pay your invoice: make a payment online with a credit card, or submit proof of payment.

Pay Online

2023-01-20 - Form created to add extra 3% Transaction Fee for all payments made via Credit Card. 2024-02-13 - Form duplicated to add ACH Payment option.

"*" indicates required fields

Step 1 of 4

Name

This field is for validation purposes and should be left unchanged.

If paying multiple invoices, please make separate payment transactions for each invoice.

Invoice Number*

Payment Amount*

Customer Number*

PO Number*

Pay by:*

Credit Card

ACH

NOTE: Your customer number is located on your invoice. Providing an accurate customer number ensures that your payment applies correctly.

ACH*

Credit Card*

American Express

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Credit Card Charges

Price: $0.00

Company Name*

Phone*

Email*

ACH Billing Address*

Credit Card Billing Address*

Submit Payment Proof

United States Your Privacy Choices