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https://secure.usaepay.com/interface/epayform/RJvRStA8P271F1m7wMytMnFKGhYh73BL/

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  <p class="centered"><b>Creditor:</b>
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      <option value="">- Select Creditor -</option>
      <!-- <option value="tkjLUckchabIxvDnjZdqVSZR6NAWkDk4">AIR Methods Trust</option> -->
      <option value="RJvRStA8P271F1m7wMytMnFKGhYh73BL">American Medical Response</option>
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      <option value="dTdE7hb5ij6m48UV88k6Svcn08EeXN0W">AT&amp;T Wireline</option>
      <option value="dTdE7hb5ij6m48UV88k6Svcn08EeXN0W">AT&amp;T U-Verse</option>
      <option value="TUgBW8ezmITwSxkKfF8MXIZpNBF9GTXa">Comcast</option>
      <!-- <option value="IUL9i8Ft8yQ11230vxTIVDzqpLofm191">Century Ambulance</option> -->
      <!-- <option value="i4PI27Y8K3g9j0MyFvjiHNDi629WFNli">Superior Amnesty</option> -->
      <option value="969c6WFyp1231pYE9qg8b8Ij4aIAbeOO">DirectTV</option>
      <option value="8oBC487unSM0IQpKBf55d0vO5201TABk">EMCare</option>
      <!-- <option value="SQ7W5jlD081uN76Wykfu2G2TAtIyBX25">Evolution Health</option> -->
      <option value="Fqd65PhdREk7dwkm6qYLJ7pzBShRTten">Falck</option>
      <!-- <option value="U9AL4Z28q16oBhquqatGK3H96U6UhD41">IGS-Senior Care</option> -->
      <option value="68B0rG5cycRKr0rl29WE8AAqt2T780l6">Pendrick</option>
      <option value="j9Q1Q9tPO854PWmQJSP7Hr30QM8XEETo">Concentra</option>
      <option value="nsOyazx86SB1sTvq1703H8DOK43z5Izg">Rural Metro</option>
      <option value="f6v5I91F4k5cG3xhEW4Ns48woCb9YC48">T-Mobile</option>
      <!-- <option value="mAKVTKXMMxbXfQLBssJ8dTQ1J4Z9r99Z">InHealth Diagnostics</option> -->
      <!-- <option value="bwzVb469EhmWI8Ucxyxzq7e7XTPGmBvz">MyLab DFW</option>
	<option value="Hhfapvc6PBzLQUQLe5WrUDEY9kBFXAPy">Infinity Laboratory</option> -->
      <!-- <option value="nWFTVALaBvCIX7Db5nnLnE00bBVtdRGW">Falck Amnesty</option> -->
      <!-- <option value="3Tg5Mx2fG1C8d08rAyUjXC8jVn0t3E2M">CRM-IGS-GEM Ambulance</option> -->
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      <!-- <option value="zOQxVApeXmrEAA93rhNdUTDQNIX42BZF">Medconverge</option> -->
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	<option value="6YNHrHvOrAUtHSmPyqee6Rj6b90X7mRv">IGS Community Care</option>
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      <option value="zJRHHh8PLFsYxy9INnwnUv3TPRfdHUvd">CRM-Cascade</option>
      <!-- <option value="f5H8dzKarMyy6zHt0IEKXhU8R1UrfOvH">CRM-Pallino Asset</option> -->
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	<option value="IZbJEC85GEgs7L1yxO1evOCHjrT3xq9E">CRM-IGS-Pruven Health</option> -->
      <!--<option value="tpLOISHAMMqJW0s6HxwQ7pKqdr4bDZ5J">Medstat</option> -->
      <!--<option value="K1zhNCeHwehmq0QA3eQ6AM6medCaNdn7">AMGH Early Out</option>-->
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      <option value="arVbGI2ctEDNB1VA0TZVCFhCITrA01ZA">Global Medical Response</option>
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      <option value="MX33eLIDyQBjA4g5bbceX4atJ5D5fFTx">Other</option>
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  <p class="centered">In which state do you currently reside? <select id="state" name="UMbillstate" required="">
      <option value="">- Select State -</option>
      <option value="AL">Alabama</option>
      <option value="AK">Alaska</option>
      <option value="AZ">Arizona</option>
      <option value="AR">Arkansas</option>
      <option value="CA">California</option>
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      <option value="CT">Connecticut</option>
      <option value="DE">Delaware</option>
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      <option value="ID">Idaho</option>
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      <option value="KS">Kansas</option>
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      <option value="MD">Maryland</option>
      <option value="MA">Massachusetts</option>
      <option value="MI">Michigan</option>
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      <option value="MO">Missouri</option>
      <option value="MT">Montana</option>
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      <option value="OK">Oklahoma</option>
      <option value="OR">Oregon</option>
      <option value="PA">Pennsylvania</option>
      <option value="RI">Rhode Island</option>
      <option value="SC">South Carolina</option>
      <option value="SD">South Dakota</option>
      <option value="TN">Tennessee</option>
      <option value="TX">Texas</option>
      <option value="UT">Utah</option>
      <option value="VT">Vermont</option>
      <option value="VA">Virginia</option>
      <option value="WA">Washington</option>
      <option value="WV">West Virginia</option>
      <option value="WI">Wisconsin</option>
      <option value="WY">Wyoming</option>
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  <p class="centered"><input type="checkbox" id="confirmMakePayment2" required=""> I have read the preceding authorization <br>regarding contact and disclosures <br>and wish to make a payment.</p>
  <p class="centered"><input name="action" value="Pay By Check" type="submit" class="submitMakePayment checks"> &nbsp; &nbsp; &nbsp; &nbsp; <input name="action" value="Pay By Credit Card" type="submit" class="submitMakePayment cc"></p>
</form>

Text Content

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WELCOME TO CREDENCE'S SECURE ON-LINE PAYMENT PORTAL


TERMS & CONDITIONS

If you require a payment for a future date, or would like to establish
additional payments for the future, please contact our office at 1-855-880-4791.

Thank you for visiting the Credence Resource Management Website. Before
proceeding please read the following terms and conditions regarding its use and
check the box below to acknowledge you understand and accept them.

Disclosure authorization: I am the individual whose name appears as the customer
on this account or I have legal authorization to act on behalf of the customer
named. If the customer is a minor, an adult under my care, or a business I own
or manage, I am duly authorized to represent the named party, disclose personal
information and conduct this transaction on their behalf.

This is an attempt to collect a debt. Any information obtained will be used for
that purpose.

Creditor: - Select Creditor - American Medical Response AT&T Mobility AT&T
Wireline AT&T U-Verse Comcast DirectTV EMCare Falck Pendrick Concentra Rural
Metro T-Mobile Envision Radiology CRM-Cascade CRM-USCC CRM-Cox Communication
Global Medical Response CRM-Dish CRM-PCP Asset Management Other

In which state do you currently reside? - Select State - Alabama Alaska Arizona
Arkansas California Colorado Connecticut Delaware District of Columbia Florida
Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine
Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska
Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota
Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota
Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

I have read the preceding authorization
regarding contact and disclosures
and wish to make a payment.

       

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