Center for Retina and Macular Disease

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First Name:	Last Name:
Billing Address:

City:	State: Zipcode:
Payment Amount:

Card Number:	CVV/CID:
	what is this? Security Code The security code (or the CVV2) is a 3- or 4-digit number printed on your credit card. This number is only printed on your card, and is not stored anywhere. The only way to know the number is to physically have the card, making this a valuable security measure. MasterCard, Visa or Discover Look on the back of your card, in the signature panel. The last three numbers are your security code. American Express: Look on the front of your card, above the embossed numbers. The four printed numbers are your security code.
Card Type:	Expiration Date:

Winter Haven
250 Avenue K, SW
Winter Haven, Florida 33880
Phone: (863) 297-5400
Fax: (863) 293-9780
Toll Free: 1-800-472-8867

Zephyrhills
6719 Gall Blvd, Suite 206
Zephyrhills, FL 33540
Phone: (813) 788-8388
Fax: (813) 783-1223

The Villages
11834 County Road 101 Suite 201
The Villages, FL 32162
Phone: (352) 751-9999
Fax: (352) 751-9992

Lakeland
2815 Lakeland Hills Blvd
Lakeland, Florida 33805
Phone: (863) 683-6699
Fax: (863) 688-3314

Sebring
4180 US Highway 27 S
Sebring, Florida 33870
Phone: (863) 385-4220
Fax: (863) 385-5635

Clermont
1735 East Hwy 50, Suite A
Clermont, Florida 34711
Phone: (352) 243-7311
Fax: (352) 243-7855

Haines City
137 Patterson Road
Haines City, FL 33844
Phone: (863) 422-5737
Fax: (863) 422-2414