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Personal Information
Fields marked with a * are REQUIRED in order for the transaction to be approved. Missing information will automatically be declined.
First Name:
*
Last Name:
*
City:
*
State:
*
Phone
*
Email Address:
*
Invoice
Please refer to your invoice and enter the number below: If you don't have an invoice number enter a short description.
Invoice Number/Description
*
Invoice Amount:
*
Note see new fee schedule as of 1/2021 above.
(no dollar signs: e.g. 50.00, not $50.00)
Credit Card Information:
VISA, MasterCard, and American Express ONLY. Discover is NOT accepted.
Cardholder Name:
*
Credit Card Number:
*
Month
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
Security Number:
*
It is a 3 or 4 digit code embossed or imprinted on the signature panel on the reverse side of Visa, MasterCard and on the front of American Express cards.
A 4% convenience fee will be applied to all transactions. This fee is to cover the processing charges and ensure smoother service for your convenience.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Math question
*
3 + 16 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Basic Fees as of 1/2024
Short Form Application $495
Exam Fee $175 (+$200 in-office fee)
Annual Fee $350
Recertification Fee $350
Forms
Additional Online Directory Form
ABC Certification Plaque Form
For detailed fees, please click
here
.