In order to open your account, we will need the following:

1. A completed Health Savings Account (HSA) Starter Kit.
2. Copy of your driver’s license.
3. Fund the account by Transfer, Rollover or Annual Contribution.

• Transfer Form for each IRA from which we will be directly receiving funds.
• Statement for each IRA to be transferred.
• Rollover Certification Form for each employer sponsored plan (401k, etc.).
• Statement for each qualified plan to be rolled over.
• Contribution Form

4. $50 Account Establishment Fee.

For more information, please contact Mountain West IRA.‍

Please choose how you prefer to complete your HSA Starter Kit: