ICVA Online Payment Form

This secure payment form is used for submission of NAVLE® testing region change fees, State NAVLE application fee, etc.

Visa or MasterCard are accepted for payment of required fees.

Once you make your fee payment, you must contact our office by email to confirm.

Contact Information

First Name^*

Last Name^*

Address^*

Address 2

Address 3

City^*

State^*

Zip

Country^*

Phone

E-Mail^*

Payment Information

Payment details

Reference Identifier^*

Payment Amount^*

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