To open a HSAToday/SummitHSA Account, the Custodian must verify your identity.  This can be done by uploading an unexpired government issued ID, such as a drivers license or passport and/or alternative forms of ID as listed below.

 

Please use this online tool to upload a picture of your ID(s).  It is best to use your smart-phone, if possible. Your phone's camera can be used to capture a picture of your ID.

 

Alternatively, you can mail a copy of your ID  to P.O. Box 55068, Little Rock, AR 72215 or fax your ID to 501-687-1409.  Be sure to include your Name, Address, and SSN.

Opening a bank account requires you to provide identification by uploading an unexpired ID.  The requirement is one Primary ID or two Secondary IDs.  You can use your IPhone or other smart phone's camera to easily capture a picture of any of the ID options below.

 

 

 

 

 

 

By clicking the "I Agree" box below, I understand that this ID request is for the establishment of my individually owned health savings account. I also attest the information on this form is true and accurate to the best of my knowledge and I submit this form with full understanding and acceptance of the provisions contained within the Account Agreement and the Bank Deposit Rate & Fees. I accept that DataPath Financial Services has been designated as my HSA Custodian holding my savings funds and Matrix Trust is the custodian for my Investments. I accept that healthcare-related charges can be debited from my account on my behalf by DataPath and by eligible providers and merchants, as if initiated by me, the Account Holder. I further accept that transactions may be denied due to insufficient account fund or if the merchant is ineligible.

To complete, please electonically sign this form by:

 

1. Typing your Full Name in Signature Line field

2. Entering your Initials

3. Entering the Signature Date