Patient Notebook

Enterprise Rescue Inc

519 E Lee St

Enterprise, AL 36330

Phone: (334) 347 - 0333

Make a Payment

Need to make a payment? Please fill out the information below and hit continue.

Error Summary

Please, correctly fill out all required fields.

1. Patient Information

First Name *

M.I.

Last Name *

NAME OF THE PATIENT

Account Number *

Call 334-347-0333 if you do not know the account number.

Email Address *

A receipt will be sent to this email address.

2. Payment Amount

Amount

IF YOU WOULD LIKE PAYMENTS TO AUTOMATICALLY COME OUT EVERY MONTH, CALL 334-347-0333 :)

3. Payment Method

Credit/Debit Card

Name on Card *

Card Number *

Expiration Date *

Security Code *

Zip Code *

Cancel