Payment for Services

DO NOT USE THIS FORM if you are making a payment for an EMT or AEMT class. log in and then click "My Acct" and then "My Enrollments" to make an EMS class payment.

First Name*

Last Name*

Organization

Address*

City*

State*

Zip*

Phone*

Email*

Invoice Number

Amount*

Comment

Total Amount

Discount Amount

Payment procesing fee

Gross Amount

Coupon

Payment method *

MasterCard, Visa, Discover, American Express
Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Payment for Services

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