Tek Service Pros Web Pay

Patient Online Bill Pay

Pay your open invoices online for Dr. Bonita
Name of Patient*

First NameLast Name
Patient Address*

Street Address

Street Address Line 2

CityState

Zip Code
Billing Address (if different than above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Services Provided or Invoice Number (if applicable)*
Enter the services this payment is for, or an Invoice #
Please check here*
Credit Card Payments are securely transmitted on this form through PayPal. You will see "BONITADELARA" on your credit card statement for today's transaction. You may also pay via credit card on PayPal's website.
Payment Amount

prevnext( X )
USDDescription

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Patient Online Bill Pay