NHC HealthCare, North Grove, L

Payment Summary

Initial Payment Date:

Sub Total:

Fees will be calculated on confirmation screen.

Customer Information

First Name:

Last Name:

Email Address:

Address Line 1:

Address Line 2:

City:

Zip:

Payment Information

Routing Number:

Account Number:

Usio, Inc. processes ACH transactions on behalf of NHC HealthCare, North Grove, L. By clicking ‘Submit’ below you agree to pay via this ACH Authorization. You acknowledge that you are voluntarily choosing to pay electronically. You understand and acknowledge that you may terminate the ACH Authorization by notifying us at support@usio.com, subject: ACH Authorization Disputes, and in such time and manner as to afford us and your bank a reasonable opportunity to act on it.