Health Savings Account Forms

Step 1: Read the Disclosures*


Step 2: Complete the Account Opening Documents*


Step 3: Mail Completed Documents

Mail all of the completed forms and with a check for the initial deposit of $25.00** to:
The Stephenson National Bank & Trust
Attn: HSA Services
1820 Hall Avenue
Marinette, WI 54143-0137

Additional Forms:

Use the Transfer Request Form if you are interested in transferring your existing HSA to SNBT from another financial institution.
Use the Designation of Beneficiary if you already have your HSA at SNBT but wish to change your beneficiary information.

*Please retain copies of all forms for your records
**$15 minimum required to open plus $10 application fee