Corporate and Maritime Administrator for the
Republic of the Marshall Islands

Pay Marshall Islands Maritime Fees On-Line

You may complete this form on-line;
the information will be sent to us via a secure Web server.
Or you can print it out, and then fax or mail it to us.


To: Accounting, International Registries, Inc.
    11495 Commerce Park Drive
    Reston, Virginia, 20191-1507
Fax: (703) 476-8522

Please note that this is a secure form.
Your credit card information will be transmitted in
encrypted format over the Internet.

Invoice Number*:
Note: if paying more than one invoice, please list invoice numbers in "Special payment instructions" area below.

Payment Amount:


Company Name:
Payee Name:

Payee Phone:

Payee Fax:
Payee E-Mail:
Contact Person:


Credit Card Type:
Credit Card is in the name of:

Credit Card Number:

Credit Card Security Code:
Expiration:


Special Payment Information

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