Make a Payment Using CareCredit? B.W Furlong & Associates Payments (Please do not make payments to Peak Performance Equine Services or Equine MRI of NJ. Click here to go to the Peak Performance Payment page.) Account Number* Account Name (farm, account name, or other) Credit Card Billing Information Billing First Name* Billing Last Name* Address* City* State* Please Select 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 Zip Code* Credit Card #* Expiration* 01 02 03 04 05 06 07 08 09 10 11 12 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Card Security Code* Where would you like the payment to go?* Pay to Oldest Statement Pay for Most Recent Statement Pay Specific Invoice Enter # Payment Distribution (How would you like your payment distributed over multiple invoices) Amount ($)* Email*
