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Health Savings Account (HSA):

Open a new account, or make contributions to or withdrawals from an existing account

Health Savings Account PDF Applications:

Open a new account or make contributions, withdrawals, or other actions with an existing account

To open a new Health Savings Account (HSA) via PDF, use with this form.

Use this HSA contribution direction form to change your yearly contribution direction on an existing account (one form per year).

Other forms are available to make changes to existing HSAs. Click on the HSA form(s) you need, to open it in a new window, where you can complete, save, and print it.

Long-Term Care Insurance:

To learn more about long-term care insurance and how you can protect yourself, e-mail us or call (650) 508-7222 or (800) 656-4096 to speak to a financial consultant in our Investment Planning department.

Pet Insurance:

Call us at (800) 310-0395 for a free quote or more information.

See Also:

If you are not a Provident member, you are required to complete and include a membership application:

Some of the "PDF" applications can be completed either before or after printing them. If you use these instead of the online application, sign your form(s) and mail to:

Provident Credit Union
Attn: Account Services
303 Twin Dolphin Drive
Redwood City, CA 94065-1409

Or, bring your completed application to any Provident Credit Union branch.

Or, you can fax your application(s) to (650) 508-0619, ATTN Account Services.

Using These Forms

The "online" application above can be completed entirely within your browser, with no plug-ins required.

The "PDF" applications require the Adobe Acrobat Reader plug-in, which is available free from Adobe. Or, you may also receive an application by stopping by or calling one of our branches, or sending us an e-mail requesting that we mail you an application.