premierbiotech.com Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST /payonline

<form action="/payonline" id="payonline_form" method="post">
  <div class="row">
    <div class="col-md-10 col-md-offset-1">
      <input data-val="true" data-val-required="The Statement # field is required." id="StatementId" name="StatementId" placeholder="Statement #, Invoice #, or Account #" type="text" value="">
      <span class="field-validation-valid" data-valmsg-for="StatementId" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="row padding-top-1">
    <div class="col-md-10 col-md-offset-1">
      <button class="loginbutton" type="submit">Continue</button>
    </div>
  </div>
</form>

Text Content

Back to Premier Biotech
Back to Premier Biotech
Pay Online by Statement or by Invoice
Continue
Account Access

Sign in by entering your statement number or invoice number and code to view
your account balance and make a payment via our secure online bill pay.

Note: This page should only be accessed by the account owner or those authorized
on the account owners behalf. By clicking Pay Online, you represent that you are
authorized to make billing decisions on this statement.