HSA - How to Open

Salisbury Bank currently does not open accounts online. Once you submit the below application, you will be contacted within 48 hours by a Customer Associate to set-up an appointment to finalize your account opening. At this time you will receive the appropriate account disclosures.

* = Required

Choose a Branch Office

Health Savings Account Information

Type of Health Insurance Plan Coverage:

Anticipated Opening Balance

Example: $125.00

Account Services

e-Banking

Additional Services

Card Services


Applicant Information

Date of Birth*

/ /

Please answer at least 3 of the following questions to help protect you and your information from potential unauthorized individuals.


Authorized Signer

Will there be an Authorized Signer?


Authorized Signer Information

Date of Birth*

/ /

Please answer at least 3 of the following questions to help protect you and your information from potential unauthorized individuals.


Designation of Beneficiary

An authorized signer’s access to the account ceases upon death, therefore, the Bank requires a beneficiary to be named. If your spouse is listed as your sole primary beneficiary, the HSA will become your spouse's HSA upon death.

Beneficiary Information

Date of Birth*

/ /

DISCLOSURE

Salisbury Bank reserves the right to utilize the provided information to obtain identity verifications and deposit relationships before opening any accounts. We may access information about you or any Authorized Signer from a credit reporting agency before opening any account. By submitting this form, I/We grant full permission to do so.

Important Information about procedures for opening a new account at Salisbury Bank and Trust Company

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.