CINXE.COM
Quick Pay
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html> <head><script type="text/javascript" src="https://web-static.archive.org/_static/js/bundle-playback.js?v=7YQSqjSh" charset="utf-8"></script> <script type="text/javascript" src="https://web-static.archive.org/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="https://web-static.archive.org/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("https://henderson.ixt.com/QuickPayAccount.aspx","20111226031808","https://web.archive.org/","web","https://web-static.archive.org/_static/", "1324869488"); </script> <link rel="stylesheet" type="text/css" href="https://web-static.archive.org/_static/css/banner-styles.css?v=p7PEIJWi" /> <link rel="stylesheet" type="text/css" href="https://web-static.archive.org/_static/css/iconochive.css?v=3PDvdIFv" /> <!-- End Wayback Rewrite JS Include --> <title>Quick Pay</title> <meta name="GENERATOR" content="Microsoft Visual Studio 7.0"> <meta name="CODE_LANGUAGE" content="C#"> <meta name="vs_defaultClientScript" content="JavaScript"> <meta name="vs_targetSchema" content="http://schemas.microsoft.com/intellisense/ie5"> <script src="/web/20111226031808js_/https://henderson.ixt.com/javascripts/ixt.js" type="text/javascript"></script> <link href="/web/20111226031808cs_/https://henderson.ixt.com/stylesheets/henderson.css" rel="stylesheet" type="text/css"> <link href="/web/20111226031808cs_/https://henderson.ixt.com/stylesheets/print.css" rel="stylesheet" type="text/css" media="print"> </head> <body onload="javascript:document.forms[0].txtAccountID1.focus();" onkeydown="return CatchEnter('btnContinue');"> <!-- begin branding/header at the top of the page --> <a name="top"></a> <div style="BACKGROUND: url(/web/20111226031808im_/https://henderson.ixt.com/images/company/banner_henderson.jpg) no-repeat; WIDTH: 100%; HEIGHT: 130px; background-position: center; background-color: #fff;"></div> <!-- end branding/header --> <!-- begin main navigation --> <div id="navigation-bar"> <div id="main-navigation-logout"> <div id="navigationbar_navbar"> </div> </div> </div> <!-- end main navigation --> <!-- begin main content --> <div id="main-content"> <h2>Quick Pay</h2> <p>Enter your account information below exactly as it appears on your statement. Refer to your most recent statement and then click "Continue".</p> <form name="QuickPayAccount" method="post" action="/web/20111226031808/https://henderson.ixt.com/QuickPayAccount.aspx" id="QuickPayAccount"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwUJNTY1ODE5NzM5D2QWAgICD2QWCAIDDw8WAh4EVGV4dAUPQWNjb3VudCBOdW1iZXI6ZGQCBw8PFgIfAAWiATxhIGhyZWY9IiMiIG9uY2xpY2s9ImphdmFzY3JpcHQ6d2luZG93Lm9wZW4oJ2hlbHBfcGRmL0NIUy9Ob3J0aE9rYWxvb3NhLnBkZicsbnVsbCwnd2lkdGg9ODAwLGhlaWdodD02MDAscmVzaXphYmxlPXllcyxtZW51YmFyPW5vLHRvb2xiYXI9bm8sc3RhdHVzPW5vJyk7Ij5IZWxwPC9hPmRkAgkPDxYCHwAFElBhdGllbnQgTGFzdCBOYW1lOmRkAg0PFgIeB1Zpc2libGVoZGR1KCSCtQOwnqwx28C1vIs52LHdvg=="/> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEWBAK8sO/0DALLsrglAsqyuCUCmJvG1Afumn0ttht4SjOsOXgGo+Fz5C1QqA=="/> <table border="0" class="form-table"> <tr> <td colspan="3"><table id="feedback_message" class="" style="VISIBILITY: hidden"> <tr> <td> <font size="2"><strong> <div id="feedback_lblMessage" style="DISPLAY: inline; WIDTH: 70px; HEIGHT: 15px" ms_positioning="FlowLayout"></div> </strong></font> </td> </tr> </table> </td> </tr> <tr> <th> <span id="lblAccountID1"><b>Account Number:</b></span></th> <td><input name="txtAccountID1" type="text" id="txtAccountID1"/></td> <th> <span id="lblLink"><a href="#" onclick="javascript:window.open('help_pdf/CHS/NorthOkaloosa.pdf',null,'width=800,height=600,resizable=yes,menubar=no,toolbar=no,status=no');">Help</a></span></th> </tr> <tr> <th> <span id="lblAccountID2"><b>Patient Last Name:</b></span></th> <td><input name="txtAccountID2" type="text" id="txtAccountID2"/></td> <td></td> </tr> <tr> <td colspan="2" align="right"> <a id="btnContinue" class="button" href="javascript:__doPostBack('btnContinue','')">Continue</a> <td></td> </tr> </table> </form> </div> <!-- end main content --> <!-- start footer --> <div id="footer"> <img src="/web/20111226031808im_/https://henderson.ixt.com/images/structure/ixt_powered_logo.gif" width="77" height="21" alt="IXT powered"> <p>漏 2011 Emdeon Business Services LLC. All rights reserved.</p> </div> <!-- end footer --> </body> </html> <!-- FILE ARCHIVED ON 03:18:08 Dec 26, 2011 AND RETRIEVED FROM THE INTERNET ARCHIVE ON 14:56:12 Feb 25, 2025. JAVASCRIPT APPENDED BY WAYBACK MACHINE, COPYRIGHT INTERNET ARCHIVE. ALL OTHER CONTENT MAY ALSO BE PROTECTED BY COPYRIGHT (17 U.S.C. SECTION 108(a)(3)). --> <!-- playback timings (ms): captures_list: 0.633 exclusion.robots: 0.033 exclusion.robots.policy: 0.02 esindex: 0.015 cdx.remote: 6.482 LoadShardBlock: 2520.013 (3) PetaboxLoader3.datanode: 1693.171 (4) PetaboxLoader3.resolve: 191.366 (2) load_resource: 197.354 -->