thctacoma.com
The Health Connection Ballard
Bradley Eyford
5429 Russell Ave NW Suite 300
thctacoma.com
(206) 783-6000

Secure Online Payments

Payment Information
Payment Amount
Contact / Shipping
First Name*
Last Name*
Email*
Address*
City*
State*
Zip*
Country*
Phone*
Billing Address
Copy Contact
Billing Address*
Billing City*
Billing State*
Billing Zip*
Billing Country*
Billing
Name On Card*
Credit Card Number*
Card Expiration Date*  / 
Card Verification Code* what's this?
First Name on Account*
Last Name on Account*
Bank Name*
Routing Number* what's this?
Verify Routing Number*
Account Number*
Verify Account Number*
*Required



Privacy Policy
The Health Connection Ballard
5429 Russell Ave NW Suite 300 Seattle, WA 98107
(206) 783-6000
Powered by Cash Practice® Systems