Online Payment

Online Payment

Richard M. Thomas, Jr., DMD, PC 300 Bull Street, Suite 301 Savannah, GA 31401 Phone: 912.234.1944
Customer E-Mail
Important: Please enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*
Account Information
Responsible Party:*						Your account info
Phone Number:*
Billing Information
First Name:*						Credit card billing info
Middle Initial:
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
Zip Code:*
Credit/Debit Card Information
Card Number:*
Expiration Month:*
Expiration Year:*
Card Brand:*
Payment Amount:*						Amount of payment

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