About this form

Use this form to pay for your New Facility Production Safety System Application. Payment varies based on the number of facility components. This form is also used to pay for facility inspections.

• If necessary, provide the following information to your bank to prevent debit blocking on the payments processed through Pay.gov: ACH Company ID =1422000030.
   
• 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