For Hospital accounts only at this time.
All fields marked with an Asterisk (*) are required.
Account Details (This information appears on your statement.)

* See example statement

* See example statement

Additional Accounts See example statement

You may enter additional account numbers and amounts if paying more than one account.
Note: Account numbers should contain no spaces or dashes.(ie. 1234567)

Account Number* Payment Amount*

Credit / Debit Card Information

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/ *

* What is this?

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Payment Terms Agreement

NOTE: If you are interested in combining accounts or setting up a monthly payment plan, please call (812) 949-5860 and speak to a customer service representative. Please allow up to 2 business days for this payment to post to your account.

Read Payment Terms

Email is required if you would like a receipt.