Make a Payment – Western Berks EMS

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I Would Like To:*

Pay an Invoice

Make a Donation

Purchase a Membership

Date of Call (from invoice)*

Account Number (from invoice)*

Invoice Amount ($)*

Name Called For*

First Last

Address of Call*

Street Address Address Line 2 City State ZIP Code

Your membership Includes:

Copays and deductibles covered for emergency ambulance transports.
3 lift assists per membership year
- Additional lift assists are $105 each after the limit is reached
Reduced member rates for wheelchair transportation
Reduced member rates for mental health transports

Your membership includes:

Emergency ambulance transports provided by WBEMS covered in full
3 lift assists per membership year
- Additional lift assists are $105 each after the limit is reached
Reduced member rates for wheelchair transportation
Reduced member rates for mental health transports

Choose Your Plan*

Member Name(s)*

Your Name*

First Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Donation Amount ($)*

Billing Address

Please enter the address where you receive the statements for your credit card if different from the one above.

Street Address Address Line 2 City State ZIP Code

Phone*

Comments

Credit Card*

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Card Number

Expiration Date

Security Code Cardholder Name

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