Make a Payment - Tucker Roussel

Use the form on this page to submit a payment for services rendered. All payments are processed by Stripe (an industry-leading payment processor), and no credit card data or other payment information will be saved on this web server. Your submission can be made as a one-time payment or an automatically recurring monthly payment. Simply select the appropriate option in the Payment Frequency field.

Name*
First Last
Email*
Phone
Reason for Payment*
Payment Amount*
Payment Frequency*
Credit Card*
Card Details
Cardholder Name
Billing Address*
Street Address Address Line 2 City State ZIP Code
Agreement
Agreement*
By filling out and submitting this form, you agree to pay Tucker Roussel the amount listed above on the schedule listed above. You reserve the right to cancel payments by contacting Tucker Roussel with a reasonable amount of time to take action before a payment is scheduled or processed.
- I agree

Agreement