Make a Payment to Bayshore Specialty RX – Bayshore Diabetes

If you experience problems submitting a payment, please contact the Bayshore Finance Department at 1-877-204-1932.

On this page you can make a payment towards your account to complete your order, by charging the balance due it to your: Visa, MasterCard, Visa Debit, MasterCard Debit or American Express credit card.

Your account number and amount due can be found on the pharmacy email, notifying you that your order is ready. Please use that email as a reference to fill out the payment form.

A receipt of your transaction will be sent to the email address you provide below.

Billing Information: Please ensure the following required fields match the name, address and postal code listed at your financial institution

* indicates a required field

Name *

Address *

Suite/Apt

City *

Province *

Postal Code *

Phone Number *

Email *
By providing your email address you authorize Bayshore to communicate with you via that email and to send you an emailed receipt.

Client/Patient Information used to identify the individual to whom Bayshore Specialty Rx - Bayshore Diabetes is providing product for

Name

Optional Convenient Service

Optional Convenient Auto Fill, Auto Bill™ Service: Bayshore Specialty Rx Ltd., ("Bayshore") would like to offer you a higher level of customer service with its "Auto Fill, Auto Bill™" Program. By selecting this box, you are on your way to a more convenient ordering experience. Bayshore will automatically bill your insurance and your co-pay (if applicable) to the credit card you use today. Your order will filled and shipped automatically, without you lifting a finger to call or ordering online. This service may be cancelled at least four (4) days prior to any refill by contacting Bayshore 1-888-236-4034 between the hours of 8am and 8pm, Monday through Friday excluding statutory holidays in the province of Ontario or by email to cancelme@bayshore.ca.

Your Payment used to authorize the charge to the credit card

Bayshore Account # (Customer ID)*

Total Amount Due

Card Number*

CVV*

Expiry*

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