Rental Payments Testbed - Horizon Health and Wellness

Make My Rent Payment - Test

Horizon clients that reside in one of our properties can use the form below to submit your monthly rent payment. Please fill out the form completely and click the Submit My Payment button at the bottom. Once your payment has been processed a confirmation email will be sent to the email address entered.

ATTENTION: This form is for rental payments only. Please do not attempt to use this form to submit payment for any other services received at Horizon.

"*" indicates required fields

IP Address:

Name*

First Last

Rental Property Information

Rental Property Address*

Street Address City State ZIP Code

Payment Amount*

Comment

Billing Information

Billing Address

Same as Rental Property Address

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name