Newman Medical Equipment and Supply
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Welcome to the Newman Medical Equipment and Supply Patient Payment Page
Returning Payee? Log into your Newman Medical Equipment and Supply account to prefill your information.
Email Address:    *
Password:    *
 Help?
Forgot Your Password?
New Payee? Create a new Newman Medical Equipment and Supply account by placing an approved order.
One Time Patient Payment Amount
Patient Payment Amount:    * (Amount processed today in real-time)
Reference / Invoice:       (If applicable)
To set up future recurring patient payments, please complete the following section:
Each Recurring Payment Amount:  
(Processed according to start date and frequency)
Frequency:  
Start Date:  
(mm/dd/yyyy)
# of future recurring Payments:  
(Do not include today's one time payment. Enter 999 for indefinite total count.)
Billing Address
Full Name:    *
Address:    *
Address 2:  
City:    *
State:    *
(only required for US and Canada addresses)
ZIP Code:    *
(all numbers without spaces or dashes)
Country:    *
Phone Number:    *
(any format without spaces)
Email Address:    *
Password:    *
Confirm Password:    *
(8 characters, at least 1 alpha and 1 numeric)
   Save customer profile?
(Password is only required if checked)
Patient Account Number:   *
Patient Name, if different:  
Billing Information
              Pay with card
Account Number:    *
(all numbers without spaces or dashes)
Visa MasterCard Discover American Express
Expiration Date:       *
CSC:    *  What is CSC?
              Pay with checking account
Routing Number:    *
(all numbers without spaces or dashes, include leading zeros)
Checking Account:    *
(all numbers without spaces or dashes, include leading zeros)
Special Instructions:  
  I agree with the Payment Terms and Conditions. *
 Help?
(please click only once to prevent duplicate orders)
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