Wake AHEC Special Payment Processing

You should only use this form if specifically directed by a Wake AHEC staff member. Once you enter the information below and click the Continue button, you will be directed to the PayPal hosted payment form where your credit card transacction will be processed. We accept American Express, VISA, MasterCard, and Discover.  If you have any questions or concerns, please call 1-866-341-1814 (toll free) or (919) 350-8547 during business hours:  9am - 4pm (US, Eastern Time), Monday - Friday. 


*Required Fields Payment Information
*Payment type:
 
*Payment Amount:
*Description of Payment:
*Your First Name:
*Your Last Name:
*Your Email Address:
*Who at Wake AHEC instructed you to use this payment form?


*
Please enter the letters and/or numbers you see above.: