Useful Forms
Find the common forms you need for your Patelco accounts, including HSA and IRAs, below.
HSA Forms
Here's our most popular HSA forms. Check out the addresses below for where to send forms for both new and existing HSAs.
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- HSA Contribution Eligibility (PDF)
- HSA Mail Application and Eligibility (PDF)
- HSA Transfer Request (PDF)
- HSA Beneficiary Designation (PDF)
- HSA Contribution and Investment (PDF)
- HSA Employer Contribution (PDF)
- HSA Withdrawal Authorization (PDF)
- HSA Qualified Funding (PDF)
- HSA Eligibility and Information (PDF)
- HSA Mistaken Distribution Repayment (PDF)
Other Account Forms
Most account forms can be sent back to us via online banking, paper mail, or taken to a branch. Check out the form or contact us if you have questions about how to return the form.
- Direct Deposit Authorization (PDF)
- Automatic Transfers Incoming & Outgoing (ACH) (PDF)
- DBA Account Application (PDF)
- Designation of Beneficiary (PDF)
- Payroll Disbursement (PDF)
- Indemnity Agreement (PDF)
- Universal Signature Card (PDF)
- Change of Address (PDF)
- Written Statement of Unauthorized Debit (PDF)
- Affidavit of Forgery (Check Fraud) (PDF)
- Request to Close Account (PDF)
- NSF Protection (PDF)
- Termination of Joint Owner (PDF)
- Affidavit Declaration for Collection of Decedent's Account (PDF)
IRA Forms
Here's our most popular IRA forms. Check out the address below for where to send IRA forms.
Return Forms by Postal Mail
We accept payments and forms at our secure PO Boxes.
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Send Deposits, Loan and Credit Card payments
Patelco Credit Union
PO Box 2227
Merced,CA 95344 -
Send IRA and new HSA forms
Patelco Credit Union
3 Park Place
Dublin, CA 94568 -
Send forms for existing HSA
Patelco Credit Union
PO Box 2227
Merced,CA 95344