Convenient Electronic Payments

Enroll in Electronic Funds Transfer (EFT) to automatically pay your monthly patient account balance from your checking or savings account.

✓ Secure electronic processing
✓ Automatic
✓ Helps avoid missed or late payments
✓ No checks or stamps required
✓ Choose your preferred withdrawal date

Flexible Payment Options

Choose the option that works best for you:

✓ Fixed monthly payment amount (payment plans only)
✓ Variable monthly payment amount
✓ Your preferred monthly withdrawal date

Secure Online Enrollment

Our EFT Authorization Form is completed securely through DocuSign

Payment Schedule

• You may select your preferred monthly withdrawal date.
• Enrollment requests typically take 1-3 business days to process.
• Changes or cancellations must be submitted in writing prior to the next scheduled withdrawal date.
• Requests received too close to a scheduled withdrawal date may not take effect until the following payment cycle

Before You Begin

To complete the secure EFT Authorization Form, you must be authorized to approve transactions for the bank account being used.

Please have the following available:

• Bank routing number
• Bank account number
• Name on the account
• Desired withdrawal amount

Need Help?

Questions about enrollment or billing?
Please contact our Corporate Office and request to speak with a billing associate.

Phone: (402) 873-7791
E-mail: billing@ambhealthsys.com

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