Home Racing Payment Form ACH Racing Payment Form ACH Text field This payment page is only for Electronic Checks. To Make a payment using a Credit Card please use Credit Card Payments page. Customer Information First Name Last Name License / Customer / Vendor Number # Email @ Phone Number # Address Address City/Town State/Province ArizonaAlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Products License RC License $15 Fingerprint RC Fingerprint $22 Replacement License Racing Replacement License $7 Miscellaneous License Racing Miscellaneous License Misc. Amount $ Fines & Penalties-GF-R030 Racing Fines & Penalties-GF-R030 Amount $ Fines & Penalties 5% RHA-R030 Racing Fines & Penalties 5% RHA-R030 Amount $ Racing Miscellaneous License - Add Comments Payment Detail Preview Leave this field blank