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Please enter your billing information exactly as it appears on your credit card statement.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Comments
Calculated Price
Total
$0.00
About Security Credit card charges processed through our website are encrypted for your privacy and security using industry-recognized safeguards. When you use your credit on our website, rest assured that your transaction information is transmitted over a secure connection. Our servers use Secure Sockets Layer (SSL), an advanced encryption technology that works with Netscape Navigator (versions 2.0 and above), Microsoft Internet Explorer (version 3.0 and above), and AOL (AOL 3.0 and above). This technology safeguards your personal information when it is transmitted to us.
Note: All funds will be deposited into a Physicians Holding Account under the name of Total Access Medical before being transferred directly to your physician’s account.