Thank you for choosing Heritage Bank for your HSA Account. For your convenience, you can fill in our HSA application form online, (secure, encrypted transmission), or you can print a blank form and complete it by hand and mail it to us at either of the Heritage Bank addresses provided on the form.

This gives us all the information we need to prepare your HSA Plan document and account documents. We generally process all applications within 24-48 hours of receipt, so please be watching your mail for a large, white envelope from Heritage Bank containing several documents for you to sign and return to us. Your account will be officially opened once we receive the signed paperwork back from you in the mail and your paid application fee.

We look forward to working with you, and we appreciate your business!

Online Application Form
Print Blank Application Form (PDF)