LEVELUP MD URGENT CARE
(212) 863-0599
hhaoffice@levelupuc.com
100 Challenger Road
Ridgefield Park, NJ 07660
LEVELUP MD PAYMENTS
SECURE PAYMENT FORM
Amount
*
Invoice / Description
You are making a payment of
$0
to
LevelUp MD Urgent Care
Billing Information
First Name
*
Last Name
*
Company
Street
Country
State
City
Zip
*
Email
*
Phone
Select Payment Method
Credit Card
ACH
Card Number
*
Expiration Date
*
Month
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
 
Year
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
CVV
*
Total:
$0.00
Pay
A
Zelle / QuickPay:
Pay easily, fast and secure with PayPal
Pay
Account Number
*
Routing Number
*
Account Type
Checking
Savings
Pay