Our site has moved to:  WWW.LILBURNINTERNALMEDICINE.COM

 

PAYPal

<form action="https://www.paypal.com/cgi-bin/webscr" method="post">
<input type="hidden" name="cmd" value="_xclick">
<input type="hidden" name="business" value="mtrentel7@hotmail.com">
<input type="hidden" name="item_name" value="Patient Balance">
<input type="hidden" name="item_number" value="Payment">
<input type="hidden" name="amount" value="34.00">
<input type="hidden" name="no_shipping" value="0">
<input type="hidden" name="no_note" value="1">
<input type="hidden" name="currency_code" value="USD">
<input type="hidden" name="lc" value="US">
<input type="hidden" name="bn" value="PP-BuyNowBF">
<input type="image" src="https://www.paypal.com/en_US/i/btn/btn_paynowCC_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!">
<img alt="" border="0" src="https://www.paypal.com/en_US/i/scr/pixel.gif" width="1" height="1">
</form>

 

https://www.paypal.com/cgi-bin/webscr?cmd=_xclick&business=mtrentel7%40hotmail%2ecom&item_name=Patient%20Balance&item_number=Payment&amount=34%2e00&no_shipping=0&no_note=1&currency_code=USD&lc=US&bn=PP%2dBuyNowBF&charset=UTF%2d8

Intuit Payment Processor

 

 

 

 

Send mail to administrator@drfaithgray.com with questions or comments about this web site.
Copyright 2008 Faith M Gray, M.D.
Last modified: August 13, 2008
 


Our site has moved to:  WWW.LILBURNINTERNALMEDICINE.COM

 

PAYPal

<form action="https://www.paypal.com/cgi-bin/webscr" method="post">
<input type="hidden" name="cmd" value="_xclick">
<input type="hidden" name="business" value="mtrentel7@hotmail.com">
<input type="hidden" name="item_name" value="Patient Balance">
<input type="hidden" name="item_number" value="Payment">
<input type="hidden" name="amount" value="34.00">
<input type="hidden" name="no_shipping" value="0">
<input type="hidden" name="no_note" value="1">
<input type="hidden" name="currency_code" value="USD">
<input type="hidden" name="lc" value="US">
<input type="hidden" name="bn" value="PP-BuyNowBF">
<input type="image" src="https://www.paypal.com/en_US/i/btn/btn_paynowCC_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!">
<img alt="" border="0" src="https://www.paypal.com/en_US/i/scr/pixel.gif" width="1" height="1">
</form>

 

https://www.paypal.com/cgi-bin/webscr?cmd=_xclick&business=mtrentel7%40hotmail%2ecom&item_name=Patient%20Balance&item_number=Payment&amount=34%2e00&no_shipping=0&no_note=1&currency_code=USD&lc=US&bn=PP%2dBuyNowBF&charset=UTF%2d8

Intuit Payment Processor

 

 

 

 

Send mail to administrator@drfaithgray.com with questions or comments about this web site.
Copyright 2008 Faith M Gray, M.D.
Last modified: August 13, 2008