Enter Your Transaction Information

Who you are paying:

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, , Specialties:

Who received the treatment?

Optional
Provide the patient's name for payment reconciliation. The patient name can be different from the cardholder name.

What is your provider statement information?

This is the unique identifier found on your provider's bill (See example).
If none, type none (This is not your CareCredit card number).
$
The portion of this service which I am paying for has been or will be completed within 30 days from today's date.

What is your CareCredit account information?

For servicing/payment confirmation.