nys division of corporations credit card authorization form
Credit Card Authorization - New York State Department of State
To pay fees using a credit card, simply complete and sign this form and attach it to your application. We process credit card payments upon receipt. Please
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Credit-Card-Authorization-Form.pdf
Directions: Please complete this form, place it in a sealed envelope, and deposit it in the payment slot on the Bursars Office door. NAME: ID NUMBER:.
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New York State Electronic Medicaid System UB04 Billing
This document is customized for SSHSP/PSHSP providers and should be used by the provider as an instructional, as well as a reference tool.
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