GOV-PAY online

EMS

1011 West Loop
El Campo, Texas 77437
979-541-5000

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Patient Information

Notices:

Gov-Pay is a 3rd-Party facilitator for government payments. Your Convenience Fees are calculated by Gov-Pay and added to your sub-total. The Convenience Fee will be listed as a separate charge item by GovPayFee on your Card Statement.

Once the transaction is completed, you will receive a payment confirmation email from
onlinepayments@gov-pay.com

Subtotal: $0.00

Card Convenience Fee: $0.00

Check Convenience Fee: $0.00

Total: $0.00

Billing Information

Use billing address for credit card address.

By checking this box you accept and agree to the Terms and Conditions.

I accept the one time, nonrefundable convenience fee of $

Use billing address for check address.

By checking this box you accept and agree to the Terms and Conditions.

I accept the one time, nonrefundable convenience fee of $

Convenience fees for credit cards are 2.65% of the payment amount with a $3.00 minimum. Convenience fees for checks is a $2.00 flat fee. There is a $25.00 fee for all returned checks. All fields on this form are required for payment.

City of El Campo, TX - EMS

EMS

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Billing Information

Payment Method Information

Credit Card Information

ACH Information