The below forms are available to help you open, access, and manage your HSA. All forms can be downloaded, printed and either mailed or faxed to our Customer Assistance Center. If you are enrolled in Internet Banking, some of these forms and related activities can be completed online.
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Account Set-up Forms
Sign up for an HSA
Click on the above link to begin enrollment.
Account Information Change Form
Change your name, designation of beneficiary or authorized signer.
Log in to Internet Banking to add an Authorized Signer to your account, or complete this form.
Authorized Signer Revoked
Remove an authorized signer from an account.
Designation of Beneficiaries
Designate, change or remove a beneficiary.
Log in to your Internet Banking account and click "Profile" to change your address.
Disclosures, Rates and Fees
Contribution and Withdrawal Forms
Log in to Internet Banking to set up a transfer, or submit this form.
Order Checks and Debit Cards
Log into Internet Banking to order checks and debit cards.
Excess Removal Form
Remove funds that exceed your annual contribution limit.
Distribution Reversal Form
Return funds used for non-eligible expenses.
Withdraw HSA funds.
Transfer Out Instructions
Steps for transferring to a new custodian.