I authorize Horizon Village Inc. to process the above payment of $. I also authorize Horizon Village Inc. to store this information in compliance with payment processing regulations and to charge the card listed above for future payments in accordance with their terms. I understand that to make any changes to this authorization I must contact Horizon Village Inc. prior to the payment date.
I authorize Horizon Village Inc. to process the payments as outlined in the payment schedule. I also authorize Horizon Village Inc. to store this information in compliance with payment processing regulations and to charge the card above for future payments in accordance with their terms. I understand that to make any changes to this authorization I must contact Horizon Village Inc. prior to the payment date.
Please include your Horizon Village 5-digit patient account number when submitting your payment.
If you have any questions please contact our office at 716-831-2700. Thank you for using our online convenient payment center.