Member
FDIC
Equal
Housing
Lender
Building Relationships That
Make A Difference
608-836-1616
Main HSA Page
Open My HSA
All forms signed and mail to the bank need to be notarized.
Step 1 Tell us about you
Complete online, print the form, sign, and mail.
Step 2 Account Application
Complete online, print the form, sign, and mail page two. (Retain the booklet for your records)
Step 3 Contribution Form
Complete online, print the form, sign, and mail.
Step 4
Mail completed forms with a copy of your drivers license to:
Capitol Bank
ATTN: HSA Services
710 N. High Point Road
Madison, WI 53717
Please retain copies for your records.
Optional Forms:
Distribution Use this form to define your distribution.
Change of Beneficiary Use this form to change your beneficiary.
Rollover The account holder receives the money through a distribution before rolling into an HSA at Capitol Bank from an Archer MSA or an HSA through another source. Rollovers from an IRA, HRA, or FSA are not permitted. Please call or email with questions.
Transfer A direct movement from an Archer MSA or an HSA through another source to an HSA at Capitol Bank. Transfers are non-reportable transactions. Please call or email with questions.
Capitol Bank
ATTN: HSA Services
710 N. High Point Road
Madison, WI. 53717
(608)836-1616
newaccounts@capitolbank.com
Notice: E-mail is NOT a secure form of communication; therefore, NEVER e-mail any personal information (e.g. account numbers and social security numbers). Please contact a Personal Banker at 608-836-1616 (Madison) or 608-845-0108 (Verona).
IRS rules state that an HSA must have a trustee or custodian. Capitol Bank will
act as a custodian in the set-up of Health Savings Accounts. Capitol Bank
does not sell insurance, give investment or tax advice. All personal
information, including your email address, given to Capitol
Bank is confidential.