Approved Provider Online Payment - Northeast MSD
Please fill out the following form to pay for your Individual Activity Application online and by credit card. We accept VISA, MasterCard, Discover, American Express and PayPal.
*DO NOT HIT THE BACK BUTTON OR CLICK SUBMIT PAYMENT TWICE* This will cause a duplication of your payment. If you need a copy of your payment slip contact the billing department at email@example.com for assistance.
All approved providers are required to submit their application based on our cycles (March, July & November) Application not received on the date required will incur a $500 late fee. If you are unsure about the amount due please contact our office prior initiating payment.