This payment form is intended for customers who have received medical transportation services through Samaritan EMS. Fill out the information from your invoice and click submit. Once a customer pays for services, payment will be applied to the specified invoice and customer will receive an email confirmation. There are no refunds for payments submitted. This form is for payment purposes only, we will not spam you or sell your personal information.
For questions, call 877-919-2911 or email firstname.lastname@example.org.