Late Fee $100

If you previously paid your renewal fee or inactive status request fee and were directed to pay the $100.00 late fee, please complete the fields below. If you have multiple licenses, please add an additional late fee for other licenses subject to the late fee.

Personal Information

First Name *

MI

Last Name *

Address *

City *

State *

Zip *

Preferred Phone *

Email *

License Number *

Expiration Date *

Month

Day

Year

Add Additional Late Fee

I need to add an additional late fee for a second license

Second License Number *

Expiration Date *

Month

Day

Year

I acknowledge that pursuant to A.A.C. R4-6-215(C), application fees in subsections (A)(1) and (2) are non-refundable and other fees established in subsection (A) are not refundable unless the provisions of A.R.S. § 41-1077 apply. * *

I Agree

Leave this field blank