PACE Recovery Center Financial Form

PACE Credit Card Authorization Form

If paying for our California addiction treatment program by check or wire transfer, please call 800-526-1851.

To submit your credit card information online, please fill out the secure form below.


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Type of Card:*
Billing Address*

Financial Contract for Cost of Treatment

  • All fees are non-negotiable and due and payable at time of admission.
  • By signing this contract as the responsible party for treatment fees. I further understand that all fees paid are non-refundable regardless of length of stay.
  • Deposits and payments are non-refundable & non-transferable.
  • No verbal agreement will supersede this contract.
  • I hereby agree to hold PACE Recovery Center, LLC harmless for any and all future claims resulting from this contract.
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