Form Center

2. Creating an account or logging in to Form Center is optional and is not required to submit this form.
   Please make sure to click the submit button at the bottom of this form to continue to the Payment Option. Email address is only required if you would like a copy of this form.

4. This portal is for the payment of Kansas Hazardous Materials Training invoices using a credit card, you may make a single payment if you have multiple invoices. This is a two step process - please fill out the following form. After you hit submit you will be taken to the pay by credit card button where you will complete the payment.

   For questions about your invoice or payment, please email doug.jorgensen@ks.gov. 

   The receipts will be processed each business day

   This page is to pay for Kansas Hazardous Materials Training related payments only.

6. If you do not receive a confirmation email for payment, please call 785-207-2193 for verification it was received by our office. Do not resubmit payment.
8. Please note we cannot accept American Express. We accept Visa, Mastercard and Discover.
10. Agency Name
12. Contact Name*
14. Phone Number*
    Please include area code and use hyphens to separate the numbers.
15. Email*
17. Name of Cardholder*
19. Name of Class/Event*
21. Amount You Intend to Pay on the Next Screen*
    Please enter the amount that you will pay on the next screen.
23. Invoice Number*
    If you have multiple invoice numbers - enter the invoice number hit the return key after each number.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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