Submit a payment to ZXY Hospital
  • Account Details
  • Payment Details
  • Fee Details
  • Confirm Details
This is demonstration online payment website for a fictional customer, ABC Hospital. If you have any questions or issues with this payment website, please click on the support link below to send an email. If you have a question about your customer account with us, please call us (Retail Lockbox Merchant Services) during regular business hours at (206) 624-2871. Payments made via this website should be submitted at least three business days before the due date to avoid an interruption in service and/or late fees.

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Example

5/25/2017
ZXY Hospital
Payer Name
Address Line One
Address Line Two
Test Amount
Amount


A fee will be applied to this payment. The fee amount will be added to the amount of your payment and the total payment amount will be deducted from your account.

By checking the box below you hereby confirm hereby confirm your acceptance of the fee and agree to pay the total amount indicated in accordance with this website's terms and conditions. If you do not accept the fee or the transaction total, simply close your web browser (or browser tab) to exit the payment form and cancel this payment.
Please review the details of your payment
,
$0.00
0.00
0.00