Make a Payment
To make a payment on your account, please submit your invoice or bill details, and payment information below.
Please Enter the invoice or bill number from your bill:
To ensure proper payment, please make sure this number is correct.
Payment Receipt will be send to this email address.
How much would you like to pay?
( X )
Please enter the amount of your payment.
Credit Card Details
Credit Card Number
Your billing address:
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
You're making a payment to Highland Park Emergency Room
You are making a one-time payment to your account at Highland Park Emergency Room. Charges will show on your statement as "HIGHLANDPARKER". By submitting this payment, you agree to have us charge your credit or debit card in the amount shown above. TO AVOID DUPLICATE CHARGES, PLEASE DO NOT HIT THE "SUBMIT PAYMENT" BUTTON MORE THAN ONCE.
Should be Empty: