WMU Sindecuse Health Center Payment Page

Date of Birth (Format as **/**/****)

Western ID Number (WIN, if known)

Type "Other" if you do not have a WIN

Total Amount Due:

$

Payment Info

Payment details

Card Number

Expiration Date

Security Code (CVV)

MasterCard

Billing Info

Company Name

First Name

Last Name

Address 1

Address 2

City

State

Zip/Postal Code

Country

Email Address

Phone #

Click here to make a payment