Make Payment

T-JTA Payment Form

*Please note that you do not need to submit this form unless instructed to do so by your counselor. Be sure to review with your counselor the fee for this assessment before submitting this form.

Your Personal Details

Your Full Name:

Name of test-taker #1:

Name of test-taker #2 (If applicable):

Name of your counselor:

Counselor Scoring Access Number:

Please provide a contact email address:

Billing Form

Your Billing Details

Your Full Name on Credit Card:

Credit Card Number:

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Credit Card Expiration Date:

Billing Zip code