Raleigh Capitol Ear, Nose & Throat

Secure On-Line Payment

Personal and Credit Card information is safe with our secure server and PGP software, a superior encryption algorithm (1024 bit) for e-mail.

For payment towards your balance, please enter the amount in the box below.

Patient Name

Account Number

Amount

First Name

Last Name

Address

City

State

Zip Code

Card Number

CCV

Expiration Date

Email

Phone Number

Please print a copy of your transaction receipt once you have completed your online payment.