Please note, in order to make payment through this system your provider must accept credit card payments in thier office as a form of payment. If they do not we will we will email you to information you that you must make another form of payment on your account. It is also under stood that Michigan Medical Billing Services does not bill your card, the information listed for your payment is transfered directly to your provider for your card to be run for payment in their office. If there are any issues with running your card for the payment listed we will send you an email to inform you of any issues. Your signature on this form is your authorization for your provider or providers office to run your credit card for the payment amount you indicated above. If you have any questions please let us know.