Pay Your Invoice

*Important Note for Health Industry Number (HIN) Renewal Payments*

If you are paying a HIN Renewal Invoice, please use the payment form on myHIN.org. To access the new form, click here.

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Phone

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Contact Details

Organization Name*

Contact Name*

First Last

Email*

Phone*

Payment Details

Multiple invoices can be paid at once.

Invoice Number(s)*

Invoice Item/Description*

Individual HIN Renewal FeeHINAPI Service FeeHIN Processing FeeHIN License FeeLabeler Identification Code (LIC) FeeOther

Invoice Total*

Total

Credit Card Details*

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date

Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045

Security Code   Cardholder Name

Credit Card Billing Address*

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Consent*

By checking this box, I authorize HIBCC to charge my credit card above for the agreed-upon transaction.

Signature*

Do not click the “Submit” button more than once. Doing so could result in duplicate charges to your credit card.

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