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Payment Portal


Please fill out the form below to make a payment.

  • First Name:*
  • Last Name:*
  • Email:*
  • Zip Code:*
  • Phone Number:*
  • Account Number:*
  • Invoice Number:
  • Description:

  • Card Number:*
  • CVV Code:*
  • Expiration Date:*
  • Amount:*
  • Statement Date:*

  • I authorize Med-Care diabetic & Medical supplies, inc and their subsidiaries to charge my credit card for the above amount.