secure.guampayments.com
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168.235.85.107
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Submitted URL: http://secure.guampayments.com/hplo-ems/quickpay/dphss
Effective URL: https://secure.guampayments.com/hplo-ems/quickpay/dphss
Submission: On April 08 via manual from US — Scanned from DE
Effective URL: https://secure.guampayments.com/hplo-ems/quickpay/dphss
Submission: On April 08 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /hplo-ems/quickpay/dphss
<form action="/hplo-ems/quickpay/dphss" novalidate="novalidate" id="MembershipForm" enctype="multipart/form-data" method="post" accept-charset="utf-8">
<div style="display:none;"><input type="hidden" name="_method" value="POST"><input type="hidden" name="data[_Token][key]"
value="ff4e095ef9d121dfc0a0b144ca673286135c178e75610728d391bab94fa6a1049ea680b6af20504411828e42598ffa6af6d8386d0011f98a46f536a33c497d5b" id="Token63433767" autocomplete="off"></div>
<div id="summary"></div>
<br>
<div class="ss-form-entry main-grey-head-bar">
<h3 class="ss-section-title">Who is making this payment? </h3>
<p class="hr-line"></p>
</div>
<p class="red"> <span style="font-size:11px;">* Means Required Fields</span></p>
<div class="field-group">
<div class="col-md-3">
<div class="select">
<div class="input member-form select-box-feedback-icon form-group remove-icon" aria-required="true">
<div class="ss-form-entry extra-label1" style="margin-bottom:5px;"><strong>Making payment as </strong><span class="red">*</span></div>
<span class="arr"></span>
<select name="data[GeneralPayment][payment_type]" class="field-type" autocomplete="off" id="PaymentType">
<option value="">Make a selection...</option>
<option value="Company/Organization">Company/Organization</option>
<option value="Individual">Individual</option>
</select>
<span class="form-control-feedback glyphicon glyphicon-ok"></span>
</div>
</div>
</div>
</div>
<div class="field-group only-group-show hide">
<div class="col-md-12"><strong style="font-size:16px;">Person completing this payment form or point of contact.</strong></div>
<div class="col-md-4"> <span class="input member-form form-group required" aria-required="true">
<input name="data[GeneralPayment][first_name_group]" class="field-type field-type-name compy_fname" autocomplete="off" id="firstname" type="text">
<label for="FirstName" class="input__label input-label-name"><span class="input__label-content input-label-content-name">First Name <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
<div class="col-md-4"> <span class="input member-form form-group optional">
<input name="data[GeneralPayment][middle_name_group]" class="field-type field-type-name compy_mname" autocomplete="off" id="middlename" type="text">
<label for="MiddleName" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Middle Name </span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
<div class="col-md-4"> <span class="input member-form form-group required" aria-required="true">
<input name="data[GeneralPayment][last_name_group]" class="field-type field-type-name compy_lname" autocomplete="off" id="lastname" type="text">
<label for="LastName" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Last Name <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
</div>
<div class="ss-form-entry main-grey-head-bar">
<h3 class="ss-section-title">Payer's Information</h3>
</div>
<div class="field-group">
<div class="col-md-4 only-indv-show"> <span class="input member-form form-group required" aria-required="true">
<input name="data[GeneralPayment][first_name_individual]" class="field-type field-type-name indv_fname" autocomplete="off" id="firstname_individual" type="text">
<label for="firstname_individual" class="input__label input-label-name"><span class="input__label-content input-label-content-name">First Name <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
<div class="col-md-4 only-indv-show"> <span class="input member-form form-group optional">
<input name="data[GeneralPayment][middle_name_individual]" class="field-type field-type-name indv_mname" autocomplete="off" id="middlename_individual" type="text">
<label for="middlename_individual" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Middle Name </span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
<div class="col-md-4 only-indv-show"> <span class="input member-form form-group required" aria-required="true">
<input name="data[GeneralPayment][last_name_individual]" class="field-type field-type-name indv_lname" autocomplete="off" id="lastname_individual" type="text">
<label for="lastname_individual" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Last Name <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
<div class="col-md-6 subgroup-name-field hide"> <span class="input member-form form-group required" aria-required="true">
<input name="data[GeneralPayment][group_name]" class="field-type field-type-name" autocomplete="off" id="groupname" maxlength="255" type="text">
<label for="GroupName" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Company/Organization Name <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
</div>
<div class="field-group">
<div class="price-service-section-phone">
<div class="land-repeated-form-section">
<div class="land_repeated_form">
<div class="col-md-1">
<div class="remove-section pd-0 pull-right" style="margin-top:30px;">
<button type="button" class="remove_item_repeat add-more-btn" id="remove3"><i class="fa fa-times"></i></button>
</div>
</div>
<div class="col-md-9">
<div class="ss-form-entry1 extra-label" style="margin-bottom:5px;position:relative;z-index:1;padding-left: 0;"><span class="another-no-text">Best Contact Number(s)</span> <span class="red">*</span> </div>
<div class="col-md-5 col-sm-5">
<div class="select">
<div class="input member-form select-box-feedback-icon form-group remove-icon" aria-required="true">
<div class="for_select_mobile_type">
<input id="Mobile" class="radio-custom fix-day-month radio-phone-number-options-section1 radio_acc_num" name="data[GeneralPayment][Phone][1][contact_type]" checked="" value="Mobile" type="radio">
<label for="Mobile" class="radio-custom-label">Mobile </label> <input id="Home" class="radio-custom fix-day-month radio-phone-number-options-section1 radio_acc_num"
name="data[GeneralPayment][Phone][1][contact_type]" value="Home" type="radio">
<label for="Home" class="radio-custom-label">Home</label> <input id="Work" class="radio-custom fix-day-month radio-phone-number-options-section1 radio_acc_num"
name="data[GeneralPayment][Phone][1][contact_type]" value="Work" type="radio">
<label for="Work" class="radio-custom-label">Work</label>
</div>
</div>
</div>
</div>
<div class="col-md-7 col-sm-7"> <span class="input member-form form-group area-code-field has-success input--filled">
<input name="data[GeneralPayment][Phone][1][area]" class="field-type field-area-code field-type-name only-number-area-code" autocomplete="off" id="newhomeworkareacode" value="671" type="text" maxlength="3">
<label for="NewhomeWorkPhoneNumber" class="input__label input-label-name"><span class="input__label-content input-label-content-name" style="top: -2.6em;left: -.60em;font-size: 14px;">Area Code <span class="red">
*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok" style="display: inline;"></span> </span> <span class="sep-rator">-</span> <span class="input member-form form-group contact-no-field">
<input name="data[GeneralPayment][Phone][1][tel]" class="masking-phone field-phone-num field-type field-type-name" autocomplete="off" id="newhomeworkphonenumber" type="text" maxlength="8">
<label for="NewhomeWorkPhoneNumber" class="input__label input-label-name"><span class="input__label-content input-label-content-name" style="">Phone Number <span class="red"> *</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span> </div>
</div>
</div>
<div class="land_repeated_form_append"> </div>
<div class="col-md-12 text-right add-more-field-link"> <a href="javascript:;" class="add_item_repeat-phone add-more-btn" style="display: inline-block;"><strong>+ Include Another Contact Number</strong></a> </div>
</div>
</div>
</div>
<input type="hidden" class="required_status1" value="false">
<div class="field-group">
<div class="col-md-4"> <span class="input member-form form-group no_mr_top required" aria-required="true">
<input name="data[GeneralPayment][email_address]" class="field-type field-type-name email-nospace" autocomplete="off" id="paymentemail" maxlength="255" type="text">
<label for="PaymentEmail" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Email Address <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
<div class="col-md-4"> <span class="input member-form form-group no_mr_top required" aria-required="true">
<input name="data[GeneralPayment][confirm_email]" class="field-type field-type-name confirmemail-nospace" autocomplete="off" id="PaymentConfirmEmail" type="text">
<label for="PaymentConfirmEmail" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Confirm Email Address <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
</div>
</div>
<input type="hidden" class="professional_value" value="1">
<br>
<br>
<div class="ss-form-entry main-grey-head-bar">
<h3 class="ss-section-title">Payment(s) Information</h3>
</div>
<br>
<div class="price-service-section">
<div class="land-repeated-form-section">
<div class="form-section land_repeated_form">
<div class="item-error verify_error_check "></div>
<div class="trump_test">
<div class="ss-form-entry heading-for-section">
<h4 class="ss-section-title inline-block"><span class="counter-of-stdunt">
<!--1-->
</span> <span class="non_class"></span>Professional</h4>
<div class="remove-section pd-0 pull-right">
<button type="button" class="remove_item_repeat add-more-btn" id="remove"><i class="fa fa-times"></i><span class="hd-mobile">Remove Another Professional</span></button>
</div>
</div>
<!-- <p class="hr-line remove-land-repeated"></p> -->
<p class="hr-line"></p>
<input type="hidden" name="data[PaymentTemplateFourExtended][1][purpose_count]" class="purposecount" value="1">
<p><br>
</p>
<div class="field-group hide1 ">
<div class="col-md-6">
<div class="member-information dr1" id="memcat1">
<div class="select">
<div class="input member-form required form-group remove-icon" style="margin-top:0" aria-required="true">
<div class="ss-form-entry1 extra-label" style="margin-bottom:5px;"><strong style="font-weight:600">For which Board? <span class="red">*</span>:</strong></div>
<span class="arr"></span>
<input type="hidden" value="Board" name="data[PaymentTemplateFourExtended][1][dropdown_label_name]" class="hidden_due_BoardName">
<div id="OptionLists">
<select name="data[PaymentTemplateFourExtended][1][dropdown_value]" id="BoardName" class="public-cat due_BoardName">
<option value="">Select one...</option>
<option value="Guam Board of Allied Health Examiners (GBAHE)" data-val="gbahe">Guam Board of Allied Health Examiners (GBAHE)</option>
<option value="Emergency Medical Services (EMSC)" data-val="ems">Emergency Medical Services (EMSC)</option>
<option value="Guam Board of Barbering and Cosmetology (GBBC)" data-val="gbbc">Guam Board of Barbering and Cosmetology (GBBC)</option>
<option value="Guam Board of Examiners for Dentistry (GBED)" data-val="gbed">Guam Board of Examiners for Dentistry (GBED)</option>
<option value="Guam Board of Examiners for Optometry (GBEO)" data-val="gbeo">Guam Board of Examiners for Optometry (GBEO)</option>
<option value="Guam Board of Examiners for Pharmacy (GBEP)" data-val="gbep">Guam Board of Examiners for Pharmacy (GBEP)</option>
<option value="Guam Board of Medical Examiners (GBME)" data-val="gbme">Guam Board of Medical Examiners (GBME)</option>
<option value="Guam Board of Nurse Examiners (GBNE)" data-val="gbne">Guam Board of Nurse Examiners (GBNE)</option>
<option value="Guam Board of Social Work (GBSW)" data-val="gbsw">Guam Board of Social Work (GBSW)</option>
</select>
<span class="form-control-feedback glyphicon glyphicon-ok"></span>
</div>
</div>
</div>
</div>
</div>
<input type="hidden" class="array_checked_bars" name="array_checked_bars[]">
<div class="col-md-6">
<div class="board_details">
<div class="board_items_section">
<ul>
<li class="item_for_board ems" style="display:none">
<img src="/theme/Site/site/hplo/images/emsc-logo.png">
<h4><b>Emergency Medical Services (EMSC)</b></h4>
</li>
<li class="item_for_board gbahe" style="display:none">
<img src="/theme/Site/site/hplo/images/gbahe_allied_logo.png">
<h4><b>Guam Board of Allied Health Examiners (GBAHE)</b></h4>
</li>
<li class="item_for_board gbbc" style="display:none">
<img src="/theme/Site/site/hplo/images/gbbc_logo_hplo.png">
<h4><b>Guam Board of Barbering and Cosmetology (GBBC)</b></h4>
</li>
<li class="item_for_board gbed" style="display:none">
<img src="/theme/Site/site/hplo/images/gbed_dental-caduceus-logo.png">
<h4><b>Guam Board of Examiners for Dentistry (GBED)</b></h4>
</li>
<li class="item_for_board gbeo" style="display:none">
<img src="/theme/Site/site/hplo/images/gbeo_optometry_logo.png">
<h4><b>Guam Board of Examiners for Optometry (GBEO)</b></h4>
</li>
<li class="item_for_board gbep" style="display:none">
<img src="/theme/Site/site/hplo/images/gbep_pharmacy-logo.png">
<h4><b>Guam Board of Examiners for Pharmacy (GBEP)</b></h4>
</li>
<li class="item_for_board gbme" style="display:none">
<img src="/theme/Site/site/hplo/images/gbme_logo_hplo_medical.png">
<h4><b>Guam Board of Medical Examiners (GBME)</b></h4>
</li>
<li class="item_for_board gbne" style="display:none">
<img src="/theme/Site/site/hplo/images/gbne-logo1.jpg">
<h4><b>Guam Board of Nurse Examiners (GBNE)</b></h4>
</li>
<li class="item_for_board gbsw" style="display:none">
<img src="/theme/Site/site/hplo/images/gbsw_social_logo.png">
<h4><b>Guam Board of Social Work (GBSW)</b></h4>
</li>
</ul>
</div>
</div>
</div>
</div>
<div class="for_section_proffesional_details">
<div class="ss-form-entry1 extra-label" style="margin-bottom:5px; clear:both"><strong style="font-weight:600"><span class="non_class"></span><br>Professional's Full Name</strong></div>
<div class="inline-block for_same_professional_check" style="margin-right:20px;">
<input id="sameAdd-checkbox" class="sameAdd-checkbox" name="sameAddress" value="Yes" type="checkbox" aria-invalid="false">
<label for="sameAdd-checkbox" class="radio-custom-label">
<b>Click this if the <span class="non_class"></span>Professional is the Payer making payment here.</b></label>
</div>
<input type="hidden" class="nearest_hidden_for_verify">
<div class="field-group">
<div class="col-md-4"> <span class="input member-form form-group required" aria-required="true">
<input name="data[PaymentTemplateFourExtended][1][field1_professional_value]" id="ProfessionalFname" class="field-type field-type-name professional_fname" maxlength="255" type="text">
<label for="ProfessionalFname" class="input__label input-label-name"><span class="input__label-content input-label-content-name">First Name <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
<input name="data[PaymentTemplateFourExtended][1][field1_professional]" type="hidden" class="hidden_professional_fname" value="First Name">
</div>
<div class="col-md-4"> <span class="input member-form form-group optional" aria-required="true">
<input name="data[PaymentTemplateFourExtended][1][field2_professional_value]" id="ProfessionalMname" class="field-type field-type-name professional_mname" maxlength="255" type="text">
<label for="ProfessionalMname" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Middle Name</span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
<input name="data[PaymentTemplateFourExtended][1][field2_professional]" type="hidden" class="hidden_professional_mname" value="Middle Name">
</div>
<div class="col-md-4"> <span class="input member-form form-group required" aria-required="true">
<input name="data[PaymentTemplateFourExtended][1][field3_professional_value]" id="ProfessionalLname" class="field-type field-type-name professional_lname" maxlength="255" type="text">
<label for="ProfessionalLname" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Last Name <span class="red">*</span></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
<input name="data[PaymentTemplateFourExtended][1][field3_professional]" type="hidden" class="hidden_professional_lname" value="Last Name">
</div>
</div>
<div class="field-group non_class1">
<div class="col-md-4"> <span class="input member-form form-group optional" aria-required="true">
<input name="data[PaymentTemplateFourExtended][1][field4_professional_value]" id="Professionalssn" class="field-type field-type-name type_ssn professional_ssn" maxlength="4" type="text">
<label for="Professionalssn" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Last 4 of SSN</span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
<input name="data[PaymentTemplateFourExtended][1][field4_professional]" type="hidden" class="hidden_professional_ssn" value="Last 4 of SSN">
<div class="icon-div"><i class="fa fa-info"> </i> Used for verification.</div>
</div>
<div class="col-md-4"> <span class="input member-form form-group optional" aria-required="true">
<input name="data[PaymentTemplateFourExtended][1][field5_professional_value]" id="ProfessionalDOB" class="field-type field-type-name type_of_dob professional_dob" maxlength="10" type="text" placeholder="MM-DD-YYYY">
<label for="ProfessionalDOB" class="input__label input-label-name"><span class="input__label-content input-label-content-name">Date of Birth <small>(MM-DD-YYYY)</small></span></label>
<span class="form-control-feedback glyphicon glyphicon-ok"></span> </span>
<input name="data[PaymentTemplateFourExtended][1][field5_professional]" type="hidden" class="hidden_professional_dob" value="Date of Birth">
<div class="icon-div"><i class="fa fa-info"> </i> Used for verification.</div>
</div>
</div>
</div>
<div class="clearfix"></div>
<p> </p>
<div class="parent-board-data">
<div class="web_loader1" style=" background:white; display:none; justify-content:center; align-items:center;">
<img src="/theme/Site/site/images/loading-gif.gif">
</div>
<div class="payment_option_section " style="display:none">
<h4 class="non_class1"><strong>Choose the item(s) for which you are making payment:</strong></h4>
<br>
<style>
.payyee-type-for .ss-form-entry.cursor-point[aria-expanded="true"] i.fa.fa-square-o:before {
content: "\f046" !important;
}
.warning_msg_for_amount {
margin-bottom: 10px;
background: #cb1919;
color: #fff;
font-size: 11px !important;
padding: 0px 5px;
border-radius: 3px;
margin-top: 8px;
}
</style>
<!-- check -->
<div class="baord_data"></div>
<br>
</div>
</div>
</div>
</div>
</div>
<div class="land_repeated_form_append"></div>
<div class="cus-row add_item_repeat_div">
<div class="col-md-12 text-center ">
<button type="button" class="add_item_repeat add-more-btn">+ Pay for another Professional or to another Board</button>
</div>
</div>
<br>
<p style="font-size:10px;"><b>CONVENIENCE FEE WILL APPLY:</b> A 5% Online Convenience Fee would apply to all online payments using Debit Card, Credit Card, and PayPal. This fee will be added to your amount already and you will pay it as part of
the grand total while checking-out. You can see the total amounts before checking out. The 5% convenience fee is not retained by HPLO. The fee covers the cost per transaction to make this system online payment system possible. </p>
</div>
<br>
<div id="jump_form" class="clearfix"></div>
<div class="submit-form text-center">
<div class="submit">
<input type="hidden" name="token" id="token"
value="03AFcWeA7tIea-Eyggu84s9xoUy022bZgiQHl5vsVeUcJW9tA-Yu_QPABlT00cNepIfZBb0453KKTAu7evJTbMn29TkZTkcvLanIWXQmsO77rVC06QaMdnna3lh-o_W9hw39sKy7TqT08E0s9KrsQnZtWmziFJDl4234BWD5kCOJbVsBnBopsbYGe6X1URsI9TxxdhyvVI_gBgAJnrJFgod4LHJE3PnkT2T_56_ByK_yW6x0G5lob5Z0XXYXOShWGOk8o2p__tRTs9z21YCIcY-3tgygxqZQRxDBmGCDrBWcnmDFhmgxk1IygBb55L_ki7_zwK9Fhvn5MmI-CbmWvGqyEqSU6TkANyfU4wR4CZcb6s39wx6ewNdI0sKS5zsyNk5iRYUWnhwZ74QbKmyciU9jz7OMbqbRXUVyAgz6W_fw9MPlcu1MceLrvhoqQ82KZfWjFsEMEu44QV4cEhUDGPML8363Y03KDIfMsBlGJjN55rZYmNs-iFWTanC434iBBlwvswWBFgpUqVUgK_CLv8sgDLTpSOzor9oJ99fR4y95dMEArLLcG-wnDgnSs177T5-4dkK659YeL0NfyeGqgnWMBLIsadHby7hYD-f4sj5e2oRVJzQKilxjuE2ENdSl5Uomui5oOASqndTTUgGTIZ21t1K9EjmPykuyGninAbtXkzeJNXKQMR2dBM8xObRVTBToSn_EsLj5-G">
<input type="hidden" name="action" id="action" value="application_form">
<button class="checkout-btn" type="submit" id="sub_btn" value="Submit...Continue to Next Step">Submit...<span>Continue to Next Step</span></button>
<!-- <input class="checkout-btn" type="submit" id="sub_btn" value="Submit...CONTINUE TO NEXT STEP"> -->
</div>
</div>
<div id="bottom-of-page"> </div>
</form>Text Content
Health Professional Licensing/EMS Office Department of Public Health & Social Services QUICKPAY $0.00 This is the amount you have chosen to pay. Need assistance? Click here for Support > Previous Page > Main Website > Previous Page > Main Website > Support PAY ONLINE Step 1 of 2: Payment Information EASY & SECURE - ONLINE PAYMENT FOR HEALTH PROFESSIONAL LICENSING/EMS OFFICE Note: This payment portal is to pay fees due to Health Professional Licensing/EMS Office. You would be able to make payments to your specific Board(s). ------------- Get Started! Complete the basic info in Step 1 (this page) and check-out with your Debit/Credit Card or PayPal in Step 2 (next page). The payments you make here will be credited to your account accordingly. NOTE: A 5% ONLINE CONVENIENCE FEE WILL APPLY TO ALL ONLINE PAYMENTS. WHO IS MAKING THIS PAYMENT? * Means Required Fields Making payment as * Make a selection... Company/Organization Individual Person completing this payment form or point of contact. First Name * Middle Name Last Name * PAYER'S INFORMATION First Name * Middle Name Last Name * Company/Organization Name * Best Contact Number(s) * Mobile Home Work Area Code * - Phone Number * + Include Another Contact Number Email Address * Confirm Email Address * PAYMENT(S) INFORMATION PROFESSIONAL Remove Another Professional For which Board? *: Select one... Guam Board of Allied Health Examiners (GBAHE) Emergency Medical Services (EMSC) Guam Board of Barbering and Cosmetology (GBBC) Guam Board of Examiners for Dentistry (GBED) Guam Board of Examiners for Optometry (GBEO) Guam Board of Examiners for Pharmacy (GBEP) Guam Board of Medical Examiners (GBME) Guam Board of Nurse Examiners (GBNE) Guam Board of Social Work (GBSW) * EMERGENCY MEDICAL SERVICES (EMSC) * GUAM BOARD OF ALLIED HEALTH EXAMINERS (GBAHE) * GUAM BOARD OF BARBERING AND COSMETOLOGY (GBBC) * GUAM BOARD OF EXAMINERS FOR DENTISTRY (GBED) * GUAM BOARD OF EXAMINERS FOR OPTOMETRY (GBEO) * GUAM BOARD OF EXAMINERS FOR PHARMACY (GBEP) * GUAM BOARD OF MEDICAL EXAMINERS (GBME) * GUAM BOARD OF NURSE EXAMINERS (GBNE) * GUAM BOARD OF SOCIAL WORK (GBSW) Professional's Full Name Click this if the Professional is the Payer making payment here. First Name * Middle Name Last Name * Last 4 of SSN Used for verification. Date of Birth (MM-DD-YYYY) Used for verification. CHOOSE THE ITEM(S) FOR WHICH YOU ARE MAKING PAYMENT: + Pay for another Professional or to another Board CONVENIENCE FEE WILL APPLY: A 5% Online Convenience Fee would apply to all online payments using Debit Card, Credit Card, and PayPal. This fee will be added to your amount already and you will pay it as part of the grand total while checking-out. You can see the total amounts before checking out. The 5% convenience fee is not retained by HPLO. The fee covers the cost per transaction to make this system online payment system possible. Submit...Continue to Next Step × THAT AMOUNT YOU SEE IN THE LITTLE BOX IS THE BASE AMOUNT YOU WOULD BE PAYING. IT DOES NOT INCLUDE THE 5% ONLINE CONVENIENCE FEE WHICH WOULD BE APPLIED DURING CHECK-OUT. IF THE AMOUNT DISPLAYED IS $0.00, IT MEANS YOU CANNOT CHECK OUT, UNTIL YOU COMPLETE THIS PAGE TO MAKE A PAYMENT. IF YOU'D LIKE TO CHECK-OUT, COMPLETE THE FORM ON THIS PAGE, SCROLL TO THE BOTTOM OF THIS PAGE, AND CLICK THE SUBMIT BUTTON TO CONTINUE TO THE NEXT STEP. × FOR SUPPORT RELATED TO ONLINE PAYMENTS, PLEASE CONTACT US: Skip to bottom to Submit this page Scroll down to submit × THAT AMOUNT YOU SEE IN THE LITTLE BOX IS THE BASE AMOUNT YOU WOULD BE PAYING. IT DOES NOT INCLUDE THE 5% ONLINE CONVENIENCE FEE WHICH WOULD BE APPLIED DURING CHECK-OUT. IF THE AMOUNT DISPLAYED IS $0.00, COMPLETE THIS PAGE TO MAKE A PAYMENT. IF YOU'D LIKE TO CHECK-OUT, SCROLL TO THE BOTTOM OF THIS PAGE AND CLICK THE SUBMIT BUTTON TO CONTINUE TO THE NEXT STEP. This e-commerce web system is owned and operated by 1-A GuamWEBZ. * © Copyright, All Rights Reserved. * Website Terms of Use * Site Map * Website by GuamWEBZ + Powered by GuamPayments Back to top × YOUR ENTRIES IN THE FORM HERE WOULD BE LOST IF YOU LEAVE OR RELOAD THIS PAGE. ARE YOU SURE YOU WANT TO LEAVE OR RELOAD THIS PAGE? Yes, Leave or Reload this page. No, Stay on this page.