Online Bill Payment Form Thank you! Payment Form Welcome to BEC online bill payment. Please fill this form; once you submit it you will be re-directed to a secure payment site where you can safely pay with your debit or credit card. For more information please call us at (304) 733-0809. Thank you! Patient Name (as it appears in your bill) * Phone Number * Email Address * Account Number * Amount to Pay (do not include a dollar $ sign) * Submit If you are human, leave this field blank.