DUI Program Payment

You may submit a credit card payment for the DUI Program in which you are or were enrolled, using this form.

You will be automatically sent an email confirming this submission, to the email address that is included in this form, once you have selected the “Submit” button.

We will process this payment as soon as possible, typically within one business day.

Section 1: Client Information
Section 2: Program Information
Section 3: Payment Information
Include the total payment amount that you want to be charged to your credit card.
Section 4: Credit Card Information
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