Driver's Assessment Online Bill Pay Form

Driver's Assessment Amount

Driver's Assessment ** Individuals who wish to make installment payments, please call our Clinical Assessment Unit staff at 608-280-2630

$325

Total

$0.00

Credit Card Holder (3rd party payments not accepted. Payment must be made by client; with exception of minor)

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country