Notice:
To open your HSA, you are required to complete and print the following forms as applicable.  These forms are not electronically submitted; they must be printed and signed after completion and sent to Choice Financial.

 

Instructions:

  1. Complete the HSA Application Form and Optional Forms (Automatic Contribution Form, HSA Transfer Form and Participation Form) if they are applicable to your situation.
    Note: You will not be able to move forward in printing any of the forms until ALL required fields are complete.
  2. Print and read the Disclosure Statement and file it with your records.
  3. You are required to provide copies of two forms of identification; one government issued with a photo.  Acceptable forms include: 
    - driver's license
    - passport
    - state ID card
    - U.S. military card

    The Second form could include any one of the following:
    - U.S. Social Security card
    - Certified copy of a birth certificate
    - School ID card
    - Insurance card
    - Any other document showing your name and address (for example a utility bill)

  4. Mail all printed forms and copies of identification to:

    Choice Financial
    Attn: HSA Department
    4501 23rd Avenue South
    Fargo, ND 58104

    If you have any questions or need assistance during the application process, call our HSA Hotline at 1-866-702-9033.