Please use this form to submit your
contact information. After you complete and submit this form, you will be taken to a second page where you
will be able to submit payment to us via our MDS PayPal
Virtual Cash Register.
NOTE: You DO NOT need a PayPal account to make payments
to us if you are paying with a Credit or Debit card.
If you wish to make a payment from your checking account
(eCheck) then you will need a Verified