Make a Payment

Many thanks for paying your bill promptly. Payment for services rendered allows us to maintain smooth operations here at the APT Foundation.

Billing Information - Exactly as it appears on your Credit Card
Required Fields = *
Payor Prefix
Payor First Name*
Payor Middle Initial
Payor Last Name*
Suffix (eg: Jr., Sr., II)
Billing Address*
Apt. or Suite
City*
State or Providence*
Zip/Postal*
Country*
Phone Number*
Patient ID*
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Email Address*
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Payment Information
Payment Amount*
Comments
(eg: Any relevant notes regarding this payment)
Comments
This field is for validation purposes and should be left unchanged.

Billing Information - Exactly as it appears on your Credit Card