*** STAGING ***
AOTR INVOICE
CREDIT CARD PAYMENTS
:
Please complete the form, upload a copy of the invoice, select payment type as
"Electronic Payment"
and then select
"Checkout"
button.
MAIL-IN APPLICATION
:
Please complete the form and select Payment Type as
"Mail-In Application"
and then select
"Submit"
button.
Enclose a check or money order with the printed application
(Payable to Commonwealth of PA)
.
Do not add documents, Please mail with your completed form and fee
.
First Name
Last Name
Street Address
City
State
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northwest Territories
Not Provided
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming
Yukon
Zip
InvoiceNumber
InvoiceDate
TotalAmount
Add a copy of Invoice (PDF or JPEG/JPG formats only)
PaymentType
Select a Payment Type
Electronic Payment
Mail-In Application
Electronic Payment (ePay Delete)