DUI Program Payment

You may submit a credit card payment for the DUI Program in which you are 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 Payment Information
Identify which of the following payments you are making with this charge. You may select more than one payment option. We will ADD ALL OF YOUR SELECTIONS, and will charge the total amount to the credit card you select for payment.
Section 3: Optional / Additional Payment
Section 4: Credit Card and Payment Information
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