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5. Newton Fire Department - Ambulance Service Payment
7. Patient First Name*
8. Patient Last Name*
10. Account #:*
    *Located at the top of the billing statement
11. Invoice Number:*
    *Located in the first column in the middle of the billing statement
13. Payment Amount:*
14. Quantity
15. Shipping Cost
16. Taxable
18. Note:
    A 3.95% convenience fee for online payment processing will be added at checkout.
21. Amb Svc 001-1050-1-45005
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22. Calculate Totals Proceed to Checkout

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