Payment - HSA

Please make sure you provide an accurate Smith Rouchon & Associates account number.

HSA (Health Savings Account) cards ONLY! Please provide your HSA card details.

Payment Information

Amount - $25 Minimum

Smith Rouchon & Associates Account No.

HSA Information

HSA Account No.

Expires (MM/YY)

Security Code CVV More Info

Name on the HSA

Billing Address

Address

Apartment, unit, etc. (optional)

City

State

ZIP

Contact

Phone

E-mail

By marking this box, I confirm that I am an authorized user on the health savings account given above.

I acknowledge that this is the web site of a collection agency and that this is an attempt to collect a debt, any information obtained will be used for that purpose.

By providing my name, I am attaching my electronic signature approving Smith, Rouchon & Associates, Inc. to process the payments I have set out on this page.
PLEASE NOTE: Payments entered on Saturday, Sunday or holidays will be processed the next business day. Payments entered during business hours via this site may take up to 24 hours to post to your bank/credit card account.

Refund Policy:
Refunds will be issued on any credit balances or overpayments within 3 business days of validating the credit or balance due. We will issue the credit based on the payment type made to Smith, Rouchon & Associates, consisting of a refund check, ACH deposit or credit to the card type used during your transaction. If the payment type is no longer valid, we may request in writing your authorization to refund to another type of account.

Make a One Time Payment

Payment - HSA

Payment Information

HSA Information

Billing Address

Contact