Search Locations
go
Search Site
Save BetterBorrow SmarterLearn A Lot!

Forms | Wright-Patt Credit Union

img_icon_forms_pg

Help managing your checking account or saving better with direct deposit or an HSA — the forms you need for your accounts at Wright-Patt.

Direct Deposit
Check Re-Order
Account Reconcilement
HSA Forms

HSA Application

Transfer Request - Complete this form to move your HSA assets from another financial organization to your HSA at WPCU.

Rollover Request - Complete this form if you currently have a Medical Savings Account (MSA), Flexible Spending Account (FSA) or Health Reimbursement Account (HRA) with another custodian and want to roll those funds over to your HSA at WPCU.

HSA Rollover Certification - Use this form if you have received funds from a distributing Health Savings Account (HSA), Archer Medical Savings Account (MSA), Flexible Spending Account (FSA), or Health Reimbursement Account (HRA) and want to roll those funds over to your HSA at WPCU.

Request for IRA Distribution to HSA - Use this form if you want to take money from a Traditional IRA or Roth IRA and directly move it to your HSA at WPCU. This movement is known as a "qualified funding distribution."

Adjustment Request - This form should be completed if you have made a mistaken contribution or mistaken distribution and need a correction.

Contribution Form - Use this form to make a contribution to your HSA for the prior tax year. This option is only available between January 1 and April 15.

Withdrawal Request - Complete this form if you would like to withdraw funds from your HSA. This includes withdrawals due to disability and when you have gone over your contribution limit and need to remove the excess funds to avoid incurring the tax penalties associated with exceeding the annual limit.

Beneficiary Form - Complete this form if you wish to change the beneficiaries on your HSA.

FlexBank HSA Financial Arrangements - If you have elected the Enhanced HSA and your employer is not currently paying the $2.50 monthly administrative fee, you can use this form to identify the account from which FlexBank will deduct this monthly fee.

HSA Authorized Signer - Complete this form if you wish to add an authorized signer to your HSA account.

IRA Forms

Traditional IRA Application – Complete this form to open a Traditional IRA at WPCU.

ROTH IRA Application – Complete this form to open a ROTH IRA at WPCU.

Traditional IRA Transfer Request – Complete this form to move your Traditional IRA assets from another financial organization to your Traditional IRA at WPCU.

ROTH IRA Transfer Request – Complete this form to move your ROTH IRA assets from another financial organization to your ROTH IRA at WPCU.

Direct Rollover Request – Complete this form to request a direct movement of assets from an employer-sponsored retirement plan to your IRA at WPCU.

IRA Withdrawal Authorization – Complete this form if you would like to withdraw funds from your IRA at WPCU.  This includes withdrawals due to disability and when you have gone over your contribution limit and need to remove the excess funds to avoid incurring the tax penalties associated with exceeding the annual limit.

IRA Prior Year Contribution Authorization – Complete this form to make a contribution to your IRA for the prior tax year.  This option is only available between January 1 and April 15.

Keep more of your hard-earned money. Check out our other websites:

Respect Your Money - Young Today, Money Smart TomorrowFraud Awareness - Protect Yourself From FraudWright 4 You Mortgage - A Perfect Fit

Any links to external websites are links to alternative sites not operated by WPCU. WPCU is not responsible for the content of the alternate site. The privacy and security policies of the alternate site may differ from those practiced by WPCU. WPCU does not represent you or the third party if you enter into a transaction with the third party.

Wright-Patt Credit Union is committed to providing a website that is accessible to the widest possible audience in accordance with ADA standards and guidelines. We are actively working to increase accessibility and usability of our website to everyone. If you are using a screen reader or other auxiliary aid and are having problems using this website, please contact us at (800) 762-0047 or by clicking here. All products and services available on this website are available at all Wright-Patt Credit Union branches.

View the WPCU Privacy Policy

WPCU on FacebookWPCU on TwitterWPCU on YouTubeWPCU on LinkedIn
Equal Housing HousingFederally insured by NCUA