Application Forms and Payment Authorization

Welcome to our Forms page, where you can conveniently access and complete the necessary documents for your application or authorize payments.

Application Forms

To begin or continue your journey with us, please download and complete the appropriate application form based on your needs. Be sure to carefully review all sections, fill out the required information, and provide any supporting documents as outlined.

How to Submit:

  1. Download the application form by clicking here.
  2. Fill out the form using your computer or by printing it out.
  3. Once completed, submit your form via:

    • Email: info@americahealthways.net
    • Mail: 12362 Beach Blvd, Suite 28, Stanton, CA 90680
    • In-person: Monday-Sunday: 9am to 5pm

Payment Authorization Forms

For your convenience, we offer secure online payment options. To set up a recurring payment or to authorize a one-time payment, please fill out the Payment Authorization Form.

Instructions for Payment Authorization:

  1. Download the form by clicking here.
  2. Complete the required fields with your payment details.
  3. Submit your completed form through one of the following methods:

    • Email: info@americahealthways.net
    • Mail: 12362 Beach Blvd, Suite 28, Stanton, CA 90680
    • In-person: Monday-Sunday: 9am to 5pm
Loading...