(5[1-5]\d{14}$|^2(?:2(?:2[1-9]|[3-9]\d)|[3-6]\d\d|7(?:[01]\d|20))\d{12})
4[0-9]{12}(?:[0-9]{3})?
6(?:011|5[0-9]{2})[0-9]{12}
3[47][0-9]{13}
Please type in the information to the right to start your payment. We’re going to use this information to validate your account number against our records.
Afterwards you will be redirected to another screen to continue your payment.
Account Number
(Found on the top left of your statement and begins with a Q)
Patient Balance
(The total amount due from one of your three most recent Statements)
Statement Date
(Optional)
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Version Information
Company:
Retail Lockbox
Product:
Sawdust
V 3.5.17
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