Northeast Multistate Division
Approved Provider Applicant Payment
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 professionaldev@ne-msd.org 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.