BASIC
 
HSA Enrollment Demo Welcome

You are now moving onto the Fifth Third Banking HEALTH SAVINGS ACCOUNT APPLICATION/ HSA CHECKING ACCOUNT – SIGNATURE CARD. You will be guided through the process of creating your account.

Enrollment must be completed in one session, please allow at least 30 minutes for entire process.

To complete the enrollment process, you will need the following information:
  • Participant's Name
  • Street Address
  • City
  • State
  • Zip
  • Home Phone
  • Date of Birth
  • Bank Account Information
  • Information about your Health Insurance Plan
  • Mother's Maiden Name
  • Work Phone
  • Social Security Number
  • Driver's License #
  • Driver's License State
  • Power of Attorney Social Security Number
  • Death Beneficiaries’ Social Security Number
Click here when you are ready to complete and submit your application online.

For best view, please set your screen resolution to 1024 X 768 pixels.
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