Open a Health Savings Account

Use this form to open a Gulf Coast Educators HSA. Once you submit this form, you will receive documents electronically to sign with all of your important HSA documentation.

Are you a current member/account holder at the credit union? * Required
- Yes, I already have an open membership.
- No, I will need a new membership opened.
Last three digits of member number
Please enter a number from 000 to 999.
Name * Required
First Last
Phone * Required
Email * Required
Social Security Number * Required
Occupation * Required
Employer * Required
How are you eligible for membership in the credit union? * Required
Upload Picture of Photo ID (Driver's License) * Required
Accepted file types: jpg, jpeg, png, gif.
Are you married or single? * Required
- Married
- Single
Do you want a single or family plan HSA? * Required
- Single
- Family
Would you like to add a beneficiary?
- Yes
- No
Name of beneficiary
Relationship of beneficiary
Date of Birth of Beneficiary * Required
Month
Day
Year
Comments or additional information
Four digit PIN for HSA Debit Card * Required
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