Online Bill Pay

Pay Your Bill Right Now

At Long Term Medical Supply, we believe in providing our customers with convenient services to go with the expert knowledge that they've grown to expect from our team. Using the form below, you can pay your bill through a secure online portal that ensures your payment is submitted successfully. Simply enter the required information and submit your payment. You will receive an email receipt of the payment to save in your records.

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Account Information
First Name*
Middle Name
Last Name*
Address*
Address 2
City*
State*
Zip*
Phone*
Email*
Company Name
Account Number
Billing information is different than account information.

Billing Information
First Name*
Last Name*
Address*
Address 2*
City*
State*
Zip*

Payment Information
Invoice*
Payment Amount*
PAYMENT TOTAL
Payment Method
Card Number*
Expiration Date* /
Security Code*
I would like to set up a recurring payment.
- Recurring Payment Contact Information
- Please provide us the following information to get in touch with you about setting up a recurring payment.
- Email Address*
- Phone*
I agree to pay by the above method and have read and agreed to the terms and conditions.*

Pay Your Bill Right Now

Account Information

Billing Information

PAYMENT TOTAL

Payment Method