Payment for Family Subscription

You can now join or renew your subscription to the St. Marys Ambulance Service online using your American Express, Discover, MasterCard, or Visa credit card. You may also transfer funds from your PayPal account. The cost is $40.00.

Simply complete the form below and then click the Process Payment button at the bottom of the page. You will be taken to a secure ordering page at PayPal where you can enter your billing information.

This subscription permits the St. Marys Area Ambulance Service, Inc. to collect directly from any Third Party agency whatever benefits may be available. Members of our subscription program are not responsible for any balances not covered by insurance for medically necessary ambulance services. This subscription entitles you the subscriber to unlimited emergency services and limited non-emergency transportation depending on availability. Services not covered by this subscription include but may not be limited to round trip inpatient hospital transportation and physician office transportation regardless of origin.

Typing your name below, and checking the "check box," acknowledges that you agree to the terms and conditions of the St. Marys Ambulance Service. The terms and conditions are as follows:

I, the undersigned, request that payment of Medicare benefits or other insurance benefits be made on my behalf of St. Marys Area Ambulance Service, Inc. for any ambulance service provided to me by the St. Marys Ambulance Service, Inc. I authorize any holder of medical information or documentation about me to release to the Center of Medicare and Medicaid Services and its carriers and agents, as well as to the St. Marys Area Ambulance Service, Inc. any infomation and documentation needed to determine these beneits or benefits payable for related services. 

PLEASE NOTE: If you are adding your spouse and/or other family members to this subscription, you MUST include both their name and birthdate.

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