Download, print, and fill out the form below. This is ONLY for our records. We will NOT sell, distribute, or add you to any mailing lists! We promise.
(When you open this .pdf, you can type in the fields then print
if you want, or you can simply print and fill it out by hand. If you get an error, it means you probably don't have have Adobe Reader;
it's a free download here.)
Send the form with a check for the amount to:
DMPS Business and Finance Office
Attention: Mary Juran
901 Walnut St.
Des Moines, IA 50309
This address is also on the form.
(If you are a DMPS staff member and would like to pay via an account transfer, please write your account number on the line provided on the form.)
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