Make A Recurring Payment Make a Secure Recurring Online Payment Looking to schedule a recurring payment to be charged monthly? Use the form below to create a recurring payment. Please make sure to fill out all fields correctly. If there are any questions please contact us. Thank you. If you want to make a one-time payment, please visit our One-Time Payments page. Resident Information Choose the Facility* Please Select A Location Resident Name* First Last Payment Information Room and Board Payment: Payment amount above to be applied to customer room and board only. Resident Spending Account: Use this field to designate an amount specifically allocated to a resident's spending account. Monthly Payment Amount Payment Method* Credit Card Bank Account/ACH Transfer Recurrence Type Monthly Currently, only monthly billing options are available. Number of Months* Please select a number of months for recurring payments between two (2) months and 36 months. Credit Card* American Express Discover MasterCard Visa Supported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month 01 02 03 04 05 06 07 08 09 10 11 12 Year Year 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 Security Code Cardholder Name Billing Address* Street Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific ZIP Code Email Address* Telephone Number* Notes/Memo 0 of 200 max characters Terms and Conditions* I agree to the terms and conditions. As the account holder (or authorized user) attached to this payment, I permit Aperion Care LLC to debit the amount above on today's date (or next business day) as an electronic funds transfer via ACH or credit/debit card. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF), I understand that Aperion Care LLC may at its discretion attempt to process the charge again, and agree to an additional $25 charge or amount allowable by law for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form. Attach Authorization Form (if applicable) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 15 MB. If you have a previously filled out authorization form, you may attach it here. If you are making the payments for the first time online and did not fill out a paper authorization form, you can ignore this section. FOLLOW US ON SOCIAL MEDIA Facebook Twitter LinkedIn MAKE A PAYMENT Use the link below to submit a secure online payment. MAKE A ONE-TIME PAYMENT MAKE A RECURRING PAYMENT FIND THE LOCATION FOR YOU Explore our locations to find convenient facilities offering the medical, rehabilitation, and personal services you need. FIND LOCATIONS FIND THE CARE YOU NEED From short-term rehabilitation to long-term skilled nursing, Aperion Care facilities offer you a full array of medical services. EXPLORE CARE OPTIONS Aperion Care® is a service mark of Aperion Care, Inc. The Aperion Care® trademark is used by facilities that receive consulting and marketing services from Aperion Care, but Aperion Care does not own, operate, manage or control such facilities. Each facility using the Aperion Care® trademark is independently owned and operated. Not all services, programs and/or amenities described herein may be available at each location using the Aperion Care® trademark.