Admin America
Payment Center

EMPLOYER & BROKER USE ONLY

If you are an employer or broker please use the form below to pay your Admin America monthly or annual Service Fee Invoice.

DO NOT USE THIS FORM IF YOU ARE A COBRA MEMBER OR AN FSA-HRA-HSA PLAN PARTICIPANT
TO MAKE A PAYMENT PARTICIPANTS/MEMBERS MUST CLICK HERE TO LOGIN TO YOUR ONLINE PORTAL

Invoice Number(s)

Total Amount Due(Required)

Company Name(Required)

Billing Contact Name(Required)

First Last

Billing Contact Email(Required)

Billing Contact Phone(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

CAPTCHA

39474

Questions

8:30 am – 5:00 pm EDT

Admin America, Inc.

770-992-5959 800-366-2961

Admin America
Payment Center

EMPLOYER & BROKER USE ONLY

Questions

8:30 am – 5:00 pm EDT

Admin America, Inc.

770-992-5959 800-366-2961

Admin America Payment Center

** EMPLOYER & BROKER USE ONLY **

Admin America
Payment Center

EMPLOYER & BROKER USE ONLY