S-SV EMS Online Bulk Payment Center |

Credit/Debit Cardholder's Name *

First

Last

Credit/Debit Cardholder's Email *

Credit/Debit Card Billing Address (zip code must match credit/debit card billing zip code) *

Address Line 1

Address Line 2

City

State

Zip Code

Select Applicable Bulk Fees *

EMR Certification/Recertification Fees
EMT Certification/Recertification Fees
Paramedic Accreditation Fees
MICN Authorization/Reauthorization Fees

Names & certification/license numbers of the individuals this payment is for *

Please ensure accuracy when entering the names & certification/license numbers above to ensure payments are correctly applied. Contact S-SV EMS (916-625-1702 or info@ssvems.com) with any questions you may have.

Total Amount
$0.00

Credit/Debit Card Information *
Card Number
Expiration
/
Security Code