FIS 0407 (6/18) Department of Insurance and ... - Michigan-2026

1. Click ‘Get Form’ to open the FIS 0407 Payment Sheet in the editor.
2. Begin by entering your Continuing Education Provider Name and your 4-digit Michigan provider number in the designated fields.
3. Fill in the Federal Employer Identification Number (FEIN) or Social Security Number (SSN) if you are an individual provider.
4. Indicate the quantity and amount for each fee type, ensuring accuracy as per the examples provided on the form.
5. Calculate the total amount due and ensure it matches your payment method, which should be a check or money order made payable to 'PSI Services LLC.'
6. Once completed, paperclip the Payment Sheet along with your payment to the front of your application filing before submission.

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