Get Payment Transmittal Form - Maryland Department Of The Environment - Mde Maryland

Completing the Payment Transmittal Form for the Maryland Department Of The Environment can seem daunting, but this guide will break it down into manageable steps. By following these clear instructions, you will be able to submit your payment with confidence.

Follow the steps to complete your Payment Transmittal Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the facility name in the designated field. This should be the name of your business or organization that is registered with MDE.
3. Next, fill in the 'Attn:' field with the name of the person or department that should receive the payment records.
4. Enter the suite number and the full address, including state, city, and zip code, in the appropriate fields.
5. Provide the telephone number where you can be reached for any inquiries related to this payment.
6. If your billing or mailing address differs from your facility address, fill in the separate address fields provided.
7. In the next section, indicate the amount of the check you are sending by entering the numerical value in the 'Amount of Check' field.
8. Input the check number in the 'Check No.#' field to ensure proper tracking of your payment.
9. Check the appropriate box indicating whether your facility is classified as NON-DENTAL or DENTAL.
10. You must complete the PCA, agency, object, suffix, and transaction code sections. Make sure to follow the format provided in the example section of the form.
11. Finally, include your Federal I.D. Number or Social Security Number as required by the Privacy Act Notice before submitting your form.
12. Once all fields are complete, review the form for accuracy. You can then save your changes, download, print, or share the completed form as needed.

Submit your Payment Transmittal Form online today to ensure your payment is processed efficiently.