{"id":892,"date":"2018-11-26T20:10:31","date_gmt":"2018-11-26T20:10:31","guid":{"rendered":"http:\/\/localhost:81\/wordpress\/?page_id=892"},"modified":"2020-03-23T13:21:48","modified_gmt":"2020-03-23T13:21:48","slug":"pay-my-bill","status":"publish","type":"page","link":"https:\/\/www.christusems.org\/?page_id=892","title":{"rendered":"Pay my Bill"},"content":{"rendered":"<div id=\"pl-892\"  class=\"panel-layout\" ><div id=\"pg-892-0\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-892-0-0\"  class=\"panel-grid-cell\" ><div id=\"panel-892-0-0-0\" class=\"so-panel widget widget_sow-editor panel-first-child panel-last-child\" data-index=\"0\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-editor so-widget-sow-editor-base\"\n\t\t\t\n\t\t>\n<div class=\"siteorigin-widget-tinymce textwidget\">\n\t<style type=\"text\/css\">#ipt_fsqm_form_wrap_54 .ipt_fsqm_form_logo img,\n\t#ipt_fsqm_form_wrap_54 .ipt-eform-width-restrain,\n\t#ipt_fsqm_form_wrap_54 .ipt_fsqm_form_message_restore,\n\t#ipt_fsqm_form_wrap_54 .ipt_fsqm_form_message_success,\n\t#ipt_fsqm_form_wrap_54 .ipt_fsqm_form_message_error,\n\t#ipt_fsqm_form_wrap_54 .ipt_fsqm_form_message_process,\n\t#ipt_fsqm_form_wrap_54 .ipt_fsqm_form_validation_error,\n\t#ipt_fsqm_form_wrap_54 .eform-ui-estimator {\n\t\tmax-width: 980px;\n\t\tmin-width: 240px;\n\t}\n\n\t\/**\/<\/style><div\nid=\"ipt_fsqm_form_wrap_54\"\nclass=\"ipt_uif_front ipt_uif_common ipt_fsqm_form type_1 ui-front eform-ltr eform-override-element-boxy eform-override-alignment-inherit\"\ndata-fsqmsayt=\"{&quot;auto_save&quot;:false,&quot;show_restore&quot;:true,&quot;restore&quot;:false,&quot;admin_override&quot;:false,&quot;user_update&quot;:false,&quot;interval_save&quot;:false,&quot;interval&quot;:&quot;30&quot;}\"\ndata-ui-type=\"1\"\ndata-ui-theme=\"[&quot;https:\\\/\\\/www.christusems.org\\\/wp-content\\\/plugins\\\/wp-fsqm-pro\\\/static\\\/front\\\/css\\\/material-themes\\\/light-themes\\\/purple.css?ver=4.18.0&quot;]\"\ndata-ui-theme-id=\"material-purple\"\ndata-eformanim=\"1\"\ndata-fsqmga=\"{&quot;enabled&quot;:false,&quot;manual_load&quot;:false,&quot;tracking_id&quot;:&quot;&quot;,&quot;cookie&quot;:&quot;auto&quot;,&quot;user_update&quot;:false,&quot;name&quot;:&quot;Online Bill Payment&quot;,&quot;form_id&quot;:&quot;54&quot;}\"\ndata-fsqmreset=\"{&quot;reset&quot;:false,&quot;delay&quot;:10}\"\ndata-eformreg=\"{&quot;enabled&quot;:false,&quot;username_id&quot;:&quot;ipt_fsqm_form_54_pinfo_&quot;,&quot;password_id&quot;:&quot;ipt_fsqm_form_54_pinfo_&quot;,&quot;hide_pinfo&quot;:false,&quot;hide_meta&quot;:false,&quot;meta&quot;:[]}\"\ndata-eformscroll=\"{&quot;progress&quot;:true,&quot;message&quot;:true,&quot;offset&quot;:&quot;0&quot;,&quot;scrollOnError&quot;:true}\"\ndata-eform-cookie=\"0\"\ndata-subscription-form=\"false\"\ndata-instant-subscription=\"{&quot;doable&quot;:true,&quot;config&quot;:{&quot;enabled&quot;:false,&quot;min_tab&quot;:&quot;&quot;,&quot;debounce&quot;:&quot;3000&quot;},&quot;nonce&quot;:&quot;1c97ddeab4&quot;}\"\n>\n<noscript><div\nclass=\"ipt_fsqm_form_message_noscript ui-widget ui-widget-content ui-corner-all\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div>Javascript is disabled<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-bottom\"><p>Javascript is disabled on your browser. Please enable it in order to use this form.<\/p><\/div><\/div>\n<\/noscript><style type=\"text\/css\">.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}<\/style><div\nclass=\"ipt_uif_init_loader ipt-eform-preloader-inline ipt_uif_ajax_loader\"><div\nclass=\"ipt-eform-preloader-inner\"><div\nclass=\"ipt-eform-preloader-circle\"><div\nclass=\"preloader-wrapper active\"><div\nclass=\"spinner-layer spinner-blue\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-red\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-yellow\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-green\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><\/div><\/div><div\nclass=\"ipt-eform-preloader-text\"><div\nclass=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Loading<\/div><\/div><div\nclass=\"clear\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_uif_conditional_logic\" id=\"ipt_uif_conditional_logic_54\" value=\"{&quot;logics&quot;:{&quot;ipt_fsqm_form_54_pinfo_5&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;freetype&quot;,&quot;key&quot;:&quot;0&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;value&quot;:&quot;0&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;payment&quot;,&quot;m_type&quot;:&quot;pinfo&quot;}},&quot;indexes&quot;:{&quot;ipt_fsqm_form_54_freetype_0&quot;:[&quot;ipt_fsqm_form_54_pinfo_5&quot;]},&quot;base&quot;:&quot;54&quot;}\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_timer_data\" id=\"ipt_fsqm_timer_data_54\" value=\"{&quot;type&quot;:&quot;none&quot;}\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_epoc_data\" id=\"ipt_fsqm_epoc_data_54\" value=\"{&quot;CURRENTYEAR&quot;:2026,&quot;CURRENTDATE&quot;:1780072205000,&quot;CURRENTDAY&quot;:29,&quot;CURRENTMONTH&quot;:5,&quot;CURRENTHOUR&quot;:16,&quot;CURRENTMINUTE&quot;:30,&quot;CURRENTSECOND&quot;:5,&quot;CURRENTWEEK&quot;:22,&quot;CURRENTEPOC&quot;:20602}\" \/><div\nstyle=\"display: none;\" class=\"ipt_uif_hidden_init\"><form\nmethod=\"post\" action=\"\" class=\"ipt_uif_validate_form ipt_fsqm_main_form\" id=\"ipt_fsqm_form_54\" autocomplete=\"on\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"action\" id=\"action\" value=\"ipt_fsqm_save_form\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_epoc\" class=\"eform-epoc-value\" value=\"1780072205\" \/>\n<input\ntype=\"hidden\" class=\"ipt_fsqm_form_tab_pos\" name=\"fsqm_form54_tab_pos\" value=\"0\" id=\"fsqm_form54_tab_pos\" \/>\n<input\ntype=\"hidden\" id=\"ipt_fsqm_form_data_save\" name=\"ipt_fsqm_form_data_save\" value=\"cb984bd19f\" data-sayt-exclude \/>\t\t\t<input\ntype=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F892\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"form_id\" value=\"54\" \/><div\nclass=\"ipt-eform-width-restrain\"><div\nclass=\"ipt-eform-content \"><div\ndata-settings=\"{&quot;can_previous&quot;:true,&quot;show_progress_bar&quot;:true,&quot;progress_bar_bottom&quot;:false,&quot;block_previous&quot;:false,&quot;any_tab&quot;:false,&quot;type&quot;:&quot;1&quot;,&quot;scroll&quot;:true,&quot;decimal_point&quot;:2,&quot;auto_progress&quot;:false,&quot;auto_progress_delay&quot;:&quot;1500&quot;,&quot;auto_submit&quot;:false,&quot;hidden_buttons&quot;:false,&quot;scroll_on_error&quot;:true}\" class=\"ipt_fsqm_main_tab ipt_uif_tabs horizontal\"><div\nclass=\"ipt-eform-tab-nav-wrap\"><ul><li\nid=\"ipt_fsqm_form_54_tab_0_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_54_tab_0\"><span\nclass=\"eform-tab-labels\">Make a Payment <\/span><\/a><\/li><\/ul>\n<i\nclass=\"eform-tab-nav eform-tab-nav-right ipt-icomoon-angle-right disabled eform-ripple\"><\/i>\n<i\nclass=\"eform-tab-nav eform-tab-nav-left ipt-icomoon-angle-left disabled eform-ripple\"><\/i>\n<span\nclass=\"eform-tab-passive-notifier\"><\/span>\n<span\nclass=\"eform-tab-active-notifier\"><\/span><\/div><div\nid=\"ipt_fsqm_form_54_tab_0\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_54_layout_0_inner\" class=\"ipt-eform-layout-wrapper\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[design][0][m_type]\" id=\"ipt_fsqm_form_54_design_0_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[design][0][type]\" id=\"ipt_fsqm_form_54_design_0_type\" value=\"richtext\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional\" id=\"ipt_fsqm_form_54_design_0\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_richtext\"><p><span\nstyle=\"color: #000000; font-family: arial, helvetica; font-size: small;\">For your convenience, you can pay for your transport services online. Prefer to pay by phone? Call 866-953-9106.<\/span><\/p><ul><li>CHRISTUS accepts VISA, MasterCard, and Discover credit card payments via our paypal secure payment gateway.<\/li><li>If you prefer to pay by check, please mail your payment to CHRISTUS EMS PO Box 731469 Dallas TX 75373-1469.<\/li><li>Complete the online form below. The required information can be found on your invoice.<\/li><li>Not a member? Check out our membership program to save on transporting costs.<\/li><\/ul><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[pinfo][2][m_type]\" id=\"ipt_fsqm_form_54_pinfo_2_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[pinfo][2][type]\" id=\"ipt_fsqm_form_54_pinfo_2_type\" value=\"p_name\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_p_name\" id=\"ipt_fsqm_form_54_pinfo_2\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_54_pinfo_2_value\">Patient Name<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required,custom[personName]] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_54[pinfo][2][value]\"\nid=\"ipt_fsqm_form_54_pinfo_2_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<label\nfor=\"ipt_fsqm_form_54_pinfo_2_value\">eg. John Smith<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][2][m_type]\" id=\"ipt_fsqm_form_54_freetype_2_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][2][type]\" id=\"ipt_fsqm_form_54_freetype_2_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_54_freetype_2\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_54_freetype_2_value\">Patient Date of Birth:<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_54[freetype][2][value]\"\nid=\"ipt_fsqm_form_54_freetype_2_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<label\nfor=\"ipt_fsqm_form_54_freetype_2_value\">eg. 1\/18\/68<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][5][m_type]\" id=\"ipt_fsqm_form_54_freetype_5_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][5][type]\" id=\"ipt_fsqm_form_54_freetype_5_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_54_freetype_5\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_54_freetype_5_value\">Run Number:<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_54[freetype][5][value]\"\nid=\"ipt_fsqm_form_54_freetype_5_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<label\nfor=\"ipt_fsqm_form_54_freetype_5_value\">eg. 12-55555<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][4][m_type]\" id=\"ipt_fsqm_form_54_freetype_4_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][4][type]\" id=\"ipt_fsqm_form_54_freetype_4_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_54_freetype_4\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_54_freetype_4_value\">Incident\/Account Number:<\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me  ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_54[freetype][4][value]\"\nid=\"ipt_fsqm_form_54_freetype_4_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<label\nfor=\"ipt_fsqm_form_54_freetype_4_value\">eg. C2012065432<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][3][m_type]\" id=\"ipt_fsqm_form_54_freetype_3_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][3][type]\" id=\"ipt_fsqm_form_54_freetype_3_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_54_freetype_3\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_54_freetype_3_value\">Date of Service:<\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me  ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_54[freetype][3][value]\"\nid=\"ipt_fsqm_form_54_freetype_3_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<label\nfor=\"ipt_fsqm_form_54_freetype_3_value\">eg. 5\/20\/12<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][0][m_type]\" id=\"ipt_fsqm_form_54_freetype_0_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[freetype][0][type]\" id=\"ipt_fsqm_form_54_freetype_0_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_54_freetype_0\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_54_freetype_0_value\">Amount<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required,custom[number]] ipt_uif_text\"\nmin=\"\" max=\"\" step=\"any\"\t\t\t\ttype=\"number\"\nname=\"ipt_fsqm_form_54[freetype][0][value]\"\nid=\"ipt_fsqm_form_54_freetype_0_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<label\nfor=\"ipt_fsqm_form_54_freetype_0_value\">eg. 805.29<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[pinfo][5][m_type]\" id=\"ipt_fsqm_form_54_pinfo_5_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_54[pinfo][5][type]\" id=\"ipt_fsqm_form_54_pinfo_5_type\" value=\"payment\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_payment column-vertical-heading\" id=\"ipt_fsqm_form_54_pinfo_5\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_mathematical ipt_fsqm_payment_mathematical\" id=\"ipt_fsqm_form_54_pinfo_5_mathematical\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_54_pinfo_5_value\">PayPal Gateway<\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_fancy_container\"><div\nclass=\"ipt_fsqm_payment_mathematical ipt_uif_richtext ipt_uif_mathematical\">\n<input\nname=\"ipt_fsqm_form_54[pinfo][5][value]\" type=\"hidden\" value=\"0\" data-sayt-exclude class=\"ipt_uif_mathematical_input\" data-precision=\"2\" data-formula=\"F0\" data-options=\"{&quot;useGrouping&quot;:true,&quot;separator&quot;:&quot;,&quot;,&quot;decimal&quot;:&quot;.&quot;}\" data-noanim=\"true\" \/>\n<span\nclass=\"ipt_uif_mathematical_span\">0<\/span><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkout\" id=\"ipt_fsqm_form_54_pinfo_5_checkout\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional eform-checkout-gateways-radio\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"ipt_fsqm_payment_method_radio ipt_uif_question\" data-iptfsqmpp=\"paypal_d\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_54_pinfo_5_pmethod\">Payment Method<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_conditional_input\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-condid=\"ipt_fsqm_form_54_5_payment_pp\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_54[pinfo][5][pmethod]\"\nid=\"ipt_fsqm_form_54_pinfo_5_pmethod_paypal_e\"\nvalue=\"paypal_e\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_54_pinfo_5_pmethod_paypal_e\" data-labelcon=\"&#xe18e;\">\nPaypal Payment\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional eform-checkout-gateways\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"ipt_uif_question\" id=\"ipt_fsqm_form_54_5_payment_pp\"><div\nclass=\"ipt_uif_message ipt_fsqm_uif_message_green ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><h3>\n<span\nclass=\"ipt-icomoon-checkmark-circle ipt_uif_text_icon_no_bg\"><\/span>\nPay through PayPal<\/h3><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p>You will be redirected to PayPal checkout page once you submit. After you complete your payment, you will be redirected back to our site with a confirmation.<\/p><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear\"><\/div><div\nid=\"ipt_fsqm_form_54_button_container\" class=\"ipt_fsqm_form_button_container ipt_fsqm_form_button_container--classic ipt-eform-material-button-container\"><div\nclass=\"eform-button-container-inner\">\n<button\ntype=\"submit\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_fsqm_form_button_submit medium primary-button\" name=\"ipt_fsqm_form_54_button_submit\" id=\"ipt_fsqm_form_54_button_submit\"> Submit<\/button><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/form><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_success ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><h3><i\ntitle=\"\" class=\" ipt-icomoon-checkmark-circle ipticm prefix\"><\/i>\nYour form has been submitted<\/h3><\/div><div\nclass=\"ui-widget-content ui-corner-all ipt_fsqm_success_wrap\"><p>Thank you %NAME% for taking the quiz\/survey\/feedback.<br\n\/>\nWe have received your answers. You can view it anytime from this link below:<br\n\/>\n<a\nhref=\"%TRACK_LINK%\">%TRACK_LINK%<\/a><br\n\/>\nWe have also attached a copy of your submission.<\/p><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-laptop ipticm prefix\"><\/i>\nServer Side Error<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p>We faced problems while connecting to the server or receiving data from the server. Please wait for a few seconds and try again.<\/p><p>If the problem persists, then check your internet connectivity. If all other sites open fine, then please contact the administrator of this website with the following information.<\/p><p\nclass=\"jqXHR\">\n<strong>TextStatus: <\/strong><span\nclass=\"textStatus\">undefined<\/span><br\n\/>\n<strong>HTTP Error: <\/strong><span\nclass=\"errorThrown\">undefined<\/span><\/p><\/div><\/div><div\nstyle=\"display: none\" class=\"ipt_uif_widget_box ipt_fsqm_form_message_process\"><div\nclass=\"ui-widget ui-widget-header ui-corner-all\"><style type=\"text\/css\">.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}<\/style><div\nclass=\"ipt-eform-preloader-inline ipt_uif_ajax_loader\"><div\nclass=\"ipt-eform-preloader-inner\"><div\nclass=\"ipt-eform-preloader-circle\"><div\nclass=\"preloader-wrapper active\"><div\nclass=\"spinner-layer spinner-blue\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-red\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-yellow\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-green\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><\/div><\/div><div\nclass=\"ipt-eform-preloader-text\"><div\nclass=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Processing your request<\/div><\/div><div\nclass=\"clear\"><\/div><\/div><\/div><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_validation_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-warning2 ipticm prefix\"><\/i>\n<span\nclass=\"fsqm_ve_text\">Error<\/span><\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p\nclass=\"fsqm_ve_msg\">Some error has occured.<\/p><\/div><\/div><\/div>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Javascript is disabledJavascript is disabled on your browser. Please enable it in order to use this form. Loading Make a Payment For your convenience, you can pay for your transport services online. Prefer to pay by phone? Call 866-953-9106.CHRISTUS accepts VISA, MasterCard, and Discover credit card payments via our paypal secure payment gateway.If you prefer [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":809,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-892","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/892","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.christusems.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=892"}],"version-history":[{"count":6,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/892\/revisions"}],"predecessor-version":[{"id":4555,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/892\/revisions\/4555"}],"up":[{"embeddable":true,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/809"}],"wp:attachment":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=892"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}