MedBASE Online Payment
Pay your MedBASE Invoice by Credit Card
If you would like to pay your MedBASE invoice by credit card please complete the form below.
To pay by E-Transfer send payment to billing@medbase.ca
To download a printable form to send by fax or postal mail
Click Here
Account Name
Account name is required.
Email Address
Email address is required.
Invoice #
Invoice number is required.
Amount Paid $
Amount is required.
Credit Card #
Credit Card # is required.
Expiry Date (mm/yyyyy)
Expiry Date is required.
Confirmation Code (3 digits on back of card)
Confirmation Code is required.
Name on Credit Card
Name is required.
Postal Code
Postal Code is required.
Note
Note is required.
Please add a short comment or review we can post on our website
comment is required.
Submit Request
Cancel