Payment Exception Form

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Make a Payment

If you’ve been given a link to this page, it’s likely there are special circumstances with your application that require an alternative method of payment. To ensure we are able to begin processing your application, please fill out the form below with contact details and payment information. You will receive confirmation via email of your payment. Thank You!

I would like to make a payment for:(Required)

Name(Required)

First Last

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please enter billing address associated with payment method below.

Email(Required)

FACS ID:(Required)

If your ID is FACS ID-99999, please enter 99999 only. You can find your ID in emails you received from FACS regarding your recent application.

Please enter payment amount(Required)

This is the total from the email you received regarding recent application.

Total

Credit Card

Card Details

Cardholder Name