Health Savings Account

Open Your Account

  1. Personal Information
  2. Identity Verification
  3. Opening Deposit

Secure Form

This form supports up to 256-bit SSL encryption to protect your personal information while it is in transit.

To learn more about what we do with personal information, view our Privacy Policy

Confirm Information

Please confirm this information before continuing. We'll use this information to help verify your identity.

Verify

Please answer the following questions to help us verify your identity. All questions must be answered within 10 minutes.

Fund Your Account

Now you'll setup your deposit into your new account. This money will be deposited once your new account is approved.

Thank You!

We are currently verifying your application. Here's what to expect next:

    Applicant Information

      Eligibility

        In order to open an account with Citizens State Bank you must be an existing customer or live in one of the following counties: Bosque, Freestone, Hill, Leon, Limestone, McLennan, or Navarro.

      • Please confirm your eligibility:

        OK Please confirm your eligibility: is required

  • Please enter the code to confirm your ability to view the required Portable Document Format (PDF) files. If the code isn't visible, click here to see code in new window or visit your nearest branch to apply for an account.

  • OK Error - Please enter the code to verify that you can view the required Portable Document Format (PDF) files. If the code isn't visible you will need to visit your nearest branch to apply for an account.

Basic Info

  • OK First Name is required
  • OK Last Name is required
  • OK Email Address is required
  • OK Phone is required
  • OK Date of Birth is required
  • OK Social Security Number is required

Address

  • OK Address is required
  • OK City is required
  • OK State is required
  • OK Zip Code is required
    OK Mailing address is different (Optional) is required

Mailing Address

  • OK Address is required
  • OK City is required
  • OK State is required
  • OK Zip Code is required

Previous Address

  • Have you lived at this address for less than 2 years?

    OK You must select one of the following.
  • OK Previous Address is required
  • OK City is required
  • OK State is required
  • OK Zip Code is required

Identification

  • What form of ID would you prefer to use?

    OK What form of ID would you prefer to use? is required
  • OK License Number is required
  • OK State is required
  • OK Expiration Date is required
  • OK Passport Number is required
  • OK Expiration Date is required

Tax Status

    OK Please select one of the following.

    • What is this?

    If you have any questions about how to complete this section please download instructions.

Beneficiary

  • Would you like to add a beneficiary to this account?

    OK Would you like to add a beneficiary to this account? is required
    Optional OK Beneficiary 1 is required
  • OK Name is required
  • (optional) OK Date of Birth is required
  • (optional) OK Social Security Number is required
    Optional OK Beneficiary 2 is required
  • OK Name is required
  • (optional) OK Date of Birth is required
  • (optional) OK Social Security Number is required
    Optional OK Beneficiary 3 is required
  • OK Name is required
  • (optional) OK Date of Birth is required
  • (optional) OK Social Security Number is required

Regulatory Regulations

  • OK What is your Employment Status? is required
  • Optional OK If you selected Employed, Self-Employed, Unemployed, Retired, or Disabled above, complete the following: What was/is your occupation- answer No Former Occupation, if applicable. is required

  • Are you a frequent traveler (International travel, more than 5 times per year)

    OK Are you a frequent traveler (International travel, more than 5 times per year) is required
  • Optional OK If answered yes, what countries do you travel? is required

  • Do you act as an intermediary between your clients and the bank, performing services or arranging for services to be performed on your client's behalf? (Professional Service Provider)

    OK Do you act as an intermediary between your clients and the bank, performing services or arranging for services to be performed on your client's behalf? (Professional Service Provider) is required

  • What is the source of the deposits into your account?

    OK What is the source of the deposits into your account? is required

  • Will you deposit or write checks?

    OK Will you deposit or write checks? is required

  • Will you deposit or withdrawal cash?

    OK Will you deposit or withdrawal cash? is required

  • Will you send or receive wire transactions?

    OK Will you send or receive wire transactions? is required

  • If you answered Yes above (wires); will these be sent to or received from non-US locations?

    Optional OK If you answered Yes above (wires); will these be sent to or received from non-US locations? is required
  • Optional OK If you answered Yes above (international electronic transfers); which countries do you expect to send/receive wires? is required

  • Will you send or receive electronic (non-wire) transactions? (ACH, Debit Card, P2P, Online Bill Payments)

    OK Will you send or receive electronic (non-wire) transactions? (ACH, Debit Card, P2P, Online Bill Payments) is required

  • If you answered Yes above (electronic transactions), will these be sent or received from non-US locations?

    Optional OK If you answered Yes above (electronic transactions), will these be sent or received from non-US locations? is required

  • Are you a US Citizen?

    OK Are you a US Citizen? is required

    • If you answered No above, provide proper documentation when requested (Green Card, ITIN, etc).

  • Do you have citizenship with any other country?

    OK Do you have citizenship with any other country? is required
  • Optional OK If you answered Yes above, to which other countries do you have citizenship? is required

  • Are you a Politically Exposed Person? In financial regulation, a politically exposed person is one who has been entrusted with a prominent public function.

    OK Are you a Politically Exposed Person? In financial regulation, a politically exposed person is one who has been entrusted with a prominent public function. is required

Additional Information


  • Please provide a 4 digit numeric value code. This code will be used to authenticate yourself when your eSignature documents are delivered.

    OK

    Please Enter Security Code - 4 Digit Code - Numeric Value only.

    To be used for eSignature authentication
  • OK Name of Employer is required
  • OK Occupation is required

  • Would you like a debit card for this account? If applying for a savings account it will be an ATM card only, not a debit card.

    OK Would you like a debit card for this account? If applying for a savings account it will be an ATM card only, not a debit card. is required

  • Do you sell, process or grow HEMP, CBD or Marijuana products?

    OK Do you sell, process or grow HEMP, CBD or Marijuana products? is required

    • Please click here for more information about overdraft and overdraft fees.

    Overdraft protection is only available for checking accounts.

  • Please make a selection

    OK Please make a selection is required

Joint Applicant

    Joint applicants are not available for HSA accounts.

  • Will this be a joint account?

    OK Will this be a joint account? is required

Co-Applicant Basic Info

  • OK First Name is required
  • OK Last Name is required
  • OK Email is required
  • OK Phone is required
  • OK Date of Birth is required
  • OK Social Security Number is required

Co-Applicant Address

  • OK Address is required
  • OK City is required
  • OK State is required
  • OK Zip Code is required
    Optional OK Mailing address is different is required

Co-Applicant Mailing Address

  • OK Address is required
  • OK City is required
  • OK State is required
  • OK Zip Code is required

Co-Applicant Previous Address

  • Have you lived at this address for less than 2 years?

    OK You must select one of the following.
  • OK Previous Address is required
  • OK City is required
  • OK State is required
  • OK Zip Code is required

Co-Applicant Identification

  • What form of ID would you prefer to use?

    OK What form of ID would you prefer to use? is required
  • OK License Number is required
  • OK State is required
  • OK Expiration Date is required
  • OK Passport Number is required
  • OK Expiration Date is required

Co-Applicant Tax Status

    OK Please select one of the following.

    • What is this?

    If you have any questions about how to complete this section please download instructions.

Co-Applicant Additional Information


  • Please provide a 4 digit numeric value code. This code will be used to authenticate yourself when your eSignature documents are delivered.

    OK

    Please Enter Security Code - 4 Digit Code - Numeric Value only.

    To be used for eSignature authentication
  • OK Name of Employer is required
  • OK Occupation is required

  • Please choose one

    OK Please choose one is required

  • Are you a Politically Exposed Person?

    OK Are you a Politically Exposed Person? is required

  • Would you like a debit card for this account? If applying for a savings account it will be an ATM card only, not a debit card.

    OK Would you like a debit card for this account? If applying for a savings account it will be an ATM card only, not a debit card. is required

  • Do you sell, process or grow HEMP, CBD or Marijuana products?

    OK Do you sell, process or grow HEMP, CBD or Marijuana products? is required

    • Please click here for more information about overdraft and overdraft fees.

    Overdraft protection is only available for checking accounts.

  • Please make a selection

    OK Please make a selection is required

    Important Information About Procedures for Opening a New Account:

    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.

    By submitting this application, you agree to the Kasasa Digital Technology Terms of Use Agreement.