About this form

Use this form to pay for your OCS Application for Permit to Modify APM MMS124 for mailed or faxed applications only. Please use the BSEE eWell payment link to pay for electronic applications submitted through eWell.

• If necessary, provide the following information to your bank to prevent debit blocking on the payments processed through Pay.gov: ACH Company ID =1422000004.
   
• To request a refund, visit https://www.bsee.gov/who-we-are/working-with-us/Fees-for-Services.
   

Accepted Payment Methods:

• Bank account (ACH)
• Debit or credit card

With an account you can:

• See the payments you made since you created an account.
• Store payment information so you don't have to re-enter it.
• Copy a form you already submitted the next time you need to make a payment.

To take advantage of these benefits, you can Sign In . If you don't have an existing account, you will have the option to create an account on the sign-in page. To continue as a guest user, click the 'Continue to the Form' button.