Make a Payment by Credit Card

If you experience problems submitting a payment, please contact the Bayshore Finance Department at 1-877-204-1932.

An on-screen payment receipt will be provided, if you wish a receipt via email please provide an email address which you authorize to be used for communication with you.

You will need a copy of your invoice, or remittance slip with your account number

Client/Patient Information *indicates a required field
This information is used to identify the individual to whom Bayshore is providing care.

Name*

Bayshore Account Number*

Payment/Billing Information
This information is used to authorize the charge to the credit card.

Name on Credit Card*

Phone Number*

Email
By providing your email address you authorize Bayshore to communicate with you via that email and to send you an emailed receipt.

Address*

Suite/Apt

City*

Province*

Postal Code*

Invoice Number*

Invoice Amount*

–

Total Payment

Card Number*

CVV*

Expiry*

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