** You MUST select License/Registration Type - Individual or Business **
 
Is this License/Registration for an     or a  
 
Individuals  ===>   License/Registration Number (Letters-Numbers)   -      
Date of Birth (mm/dd/yyyy)  
Social Security Number (Numbers Only)
 
OR
 
Business ===>   License/Registration Number (Letters-Numbers)   -      
Employer Identification Number (Numbers Only)
 
(The E.I.N.) is a Federal tax number for business. Your E.I.N. may be your Social Security Number.)

Payments for Disciplinary Actions can be processed at any time, independently of the status of your Licensee or your renewal date.
Disciplinary Actions payments are processed for a specific License. In the event that the user has outstanding cases for multiple Licenses (Individual and/or Facilities), payments must be processed for each separate License.

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