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Exam Fee Payment Form

Name of Applicant: *

Address: *

City: *

State *

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Phone: *

Email: *

Payment Comments:

Fee Options

PBSE(+$10 processing): $360

PBSE Late Fee: $100

CAPE(+$10 processing): $360

CAPE Late Fee: $100

Reinstatement Fee: $250

Service Charge - Applicants Outside of the US: $5

Payment Information

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$0.00

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Visa

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Exp Month *

Exp Year *

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