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By checking the box to the left, you are indicating that you give El Portal Imaging authorization to process the above payment of $.

By checking the box to the left, you are indicating that you give El Portal Imaging your authorization to process the payments as outlined in the payment schedule above using the payment method listed above. To revoke your authorization you must contact El Portal Imaging.

Thank you for using our convenient online payment center. If you have questions or need assistance please call our office at 1-209-384-4252.

El Portal Imaging
3365 G Street Suite 100
Merced, CA 95340

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