Get Hsa New / Additional Debit Card Request - Sterling Hsa

Filling out the HSA New / Additional Debit Card Request form is an important step in managing your Sterling HSA account. This guide will provide you with comprehensive instructions to ensure a smooth completion of the form, whether you are requesting a new card for yourself or additional cards for your dependents.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. In the 'Information of Current Accountholder' section, fill in your name, social security number, Sterling HSA account number, and email address. Make sure these details are accurate as they are critical for processing your request.
3. Provide your street address, city, state, and zip code. This is necessary for mailing the new debit card(s) to the correct location.
4. In the 'Request for Additional Debit Card(s)' section, indicate whether you are requesting a card for yourself, your spouse, or a dependent. For each person you request a card for, fill in the required information including their name, date of birth, and social security number.
5. Review the 'Authorization and Signature' section. By signing, you confirm that you are the authorized accountholder and that all information provided is true and correct. Ensure that you date your signature.
6. After completing the form, you can save your changes, download the document, print it out, or share it as necessary. Forward the completed form to Sterling HSA via mail, fax, or email as outlined in the document.

Complete your HSA New / Additional Debit Card Request form online today.