Coastal Bend College Testing Department’s Payment Transaction Form [Please allow 1 to 24 hours (during business operational hours) to receive confirmation of payment and a copy of
your receipt. Response time will vary
based upon volume of submissions]
This form needs to be filled out and submitted when an individual needs to
pay for an exam and would like to make the payment through the internet so
that they can schedule their exam through Coastal
Bend College’s online scheduling site – Time Tap.
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First Name of Examinee:
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Last Name of Examinee:
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Select the location where you will want to take your exam:
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Select exam type & section/(s):
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Select type of card:
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Card Number - enter a dash between each 4 digits:
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(Ex: - _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _)
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Expiration date – Month and Year
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Enter two digits for the month / four digits for the year: (Example: 06/2019)
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Enter the security code – which is on the back of the
card – 3 digits:
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Enter the first and last name of the individual paying the fee:
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Enter the relationship to the examinee – if examinee is not the
individual paying with their personal card & filling out this form.
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Phone number of card user - include area code:
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(Ex: ( _ _ _) _ _ _ - _ _ _ _)
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Enter e-mail address of card user – we will e-mail a copy
of the receipt and instructions to this e-mail:
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Today’s Date:
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[None]
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Today’s Time:
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(Enter a.m. or p.m. after time - Ex: 1:13 p.m.)
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Form created 6/12/18 Revised 8/7/19
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