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Open a Health Savings Account (HSA) by Mail

Thank you for your interest in opening a Health Savings Account (HSA) at Elevations Credit Union. Please complete the following steps in order to ensure your HSA is established accurately and efficiently:

Non-Members:
  1. Review the Membership Avenues & Membership and Account Agreement [PDF]
  2. Complete the Membership Application [PDF]
    (Select the Savings and the HSA account types)
  3. Complete the CUNA Mutual Group HSA Application [PDF].
    1. Where the form says "I instruct the credit union to invest this HSA in the following investment," indicate your choice from below:
      • HSA Checking
      • HSA Certificate (indicate 3, 6, 12, 18, 24, 36, 48 or 60-month term)
      • HSA Checking and HSA Certificate of ____ months.
    2. List your beneficiary information. List your secondary beneficiaries, if applicable.
    3. If you have designated your spouse as less than 50% primary beneficiary, your spouse will need to sign for consent.
    4. Sign and date under Account Owner's Signature. Retain the Agreement and Disclosure information for your records.
    5. Retain a copy of the Agreement and Disclosure information for your records.
Complete Application Should Contain:
  1. Membership and HSA Applications with Account Owner's Signature and date
  2. Copy of your photo ID (unexpired driver’s license, military ID, or passport)
  3. Savings deposit of $25 or more
Mail To:
Attn: Operations
Elevations Credit Union
PO Box 9004
Boulder, CO 80301
To arrange a direct transfer or rollover from another HSA or Archer Medical Savings Account, please fill out the appropriate forms: Direct Transfer Form [PDF], Rollover Form [PDF].
Members:

  1. Review the Membership and Account Agreement [PDF]
  2. Complete the Membership Application [PDF] to establish your IRA account
    (Select the Savings and the IRA account types)
  3. Complete the CUNA Mutual Group HSA Application [PDF].
    1. Where the form says "I instruct the credit union to invest this HSA in the following investment," indicate your choice from below:
      • HSA Checking
      • HSA Certificate (indicate 3, 6, 12, 18, 24, 36, 48 or 60-month term)
      • HSA Checking and HSA Certificate of ____ months.
    2. List your beneficiary information. List your secondary beneficiaries, if applicable.
    3. If you have designated your spouse as less than 50% primary beneficiary, your spouse will need to sign for consent.
    4. Sign and date under Account Owner's Signature. Retain the Agreement and Disclosure information for your records.
    5. Retain a copy of the Agreement and Disclosure information for your records.
Complete Application Should Contain:
  1. Membership and HSA Applications with Account Owner's Signature and date
  2. Copy of your photo ID (unexpired driver’s license, military ID, or passport)
Mail To:
Attn: Operations
Elevations Credit Union
PO Box 9004
Boulder, CO 80301
To arrange a direct transfer or rollover from another HSA or Archer Medical Savings Account, please fill out the appropriate forms: Direct Transfer Form [PDF], Rollover Form [PDF].