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Request Info - HSA

  • OKName is required
  • OKEmail is required
  • Phone

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    OptionalOKPhone is required
  • Which method of communication do you prefer?

    OKWhich method of communication do you prefer? is required
  • Type of Health Insurance Plan Coverage:

    OKType of Health Insurance Plan Coverage: is required
  • You will need personal information about the Beneficiary.

  • OptionalOKQuestions is required
  • Thank you for your inquiry into opening a Health Savings Account with First Robinson/First Vincennes Savings Bank. Please click the link below to Complete and Print the application. In order to complete the application, you will need to know what type of health insurance coverage you have and personal information about the beneficiary.

    After you have completed and Signed the application, Bring it to the nearest First Robinson Savings branch to get the paperwork started for your new account.

    HSA Account Application

  • OK is required