Complete all required fields. To pay the entity(s) specific fee, select the entity checkbox and subsequent option.

To make a payment not specified in the options below allowing you to key the amount paid, Click Here: Too pay the entity(s) set fee with specific options, click the following button:

Payment NOT submitted.
Verify your information is entered correctly.
Use the contact information below for assistance.

Please check that your card #, expiration date and CVC are correct.

The credit card processing system is indicating a duplicate transaction has occured. The same information has been submitted within a few minutes time frame. Check your credit card portal or contact information at the bottom of the page to ensure your paynent was successful.

First Name: * ****Required****
Last Name: * ****Required****
My primary Texas Health Resources hospital will be / is: * ****Required****
****Required**** Indicate below the Texas Health Resources facilities to which you are applying. Pay the initial or reappointment fee as indicated below. Enter the amount in the "Amount" field *



Payment Information

*** Amount *   To pay a partial fee or specify an amount select the following button: Too pay the entity(s) set fee with specific options, select the following button: ****Required****

Card Type:
Please enter information below exactly as it appears on the credit card.
Cardholder Name: * ****Required****
Card Number: * ****Required****
Card Validation Code: * Credit Card Validation Help Texas Health Heroes Fund The Card Validation Code (CVC) is a three or four digit security code printed on the back of Visa and MasterCard near the signature strip. On American Express the code is on the front of the credit card above the card number. ****Required****
Expiration Date: *
Credit Card Billing Address: * ****Required****
Credit Card Billing City: * ****Required****
Credit Card Billing State: *
Credit Card Billing Zip Code: * ****Required****

Please enter authentication challenge characters below and click Submit button only once.

**Missing Characters or Incorrect**

Payment NOT submitted.
Verify your information is entered correctly.
Use the contact information below for assistance.

Please check that your card #, expiration date and CVC are correct.

The credit card processing system is indicating a duplicate transaction has occured. The same information has been submitted within a few minutes time frame. Check your credit card portal or contact information at the bottom of the page to ensure your payment was successful.