In the space provided enter your 7 digit invoice number. The invoice number is located in the upper middle section of your invoice.
Name of Patient
In the space provided enter patient's first and last name as it appears on the invoice. No nicknames please.
Date of Service
In the space provided enter the date of service.
In the space provided enter amount you are submitting for your ambulance invoice payment.
-- Select Payment Method --
Add To Cart
State Treasurer's Office
Administrative Sign In
© Copyright Illinois State Treasurer 2012