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Checkbook HSA Application

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  • Service & Pricing Overview
  • ReSure LLC provides a comprehensive solution to Checkbook HSA formation. We look forward to working with you and facilitating every step of the process - from custodian selection to bank account set-up and all the steps between those. As part of the formation service, each ReSure client is provided a Checkbook HSA operations and compliance session with a Self-Directed HSA expert. Standard pricing is $975, which is not inclusive of HSA custodial fees. To get started, please complete the following form.
  • Your Personal Information
  • Physical Address
  • HSA-LLC Info Options
  • The central component of a Checkbook HSA is an HSA-LLC, a specially structured Limited Liability Company. Make the appropriate selection to either enter your HSA-LLC info or to schedule a discussion with a Checkbook HSA expert.
  • LLC Formation Information
  • LLC's Registered Agent Name & Address
  • Commercial registered agent services are arranged by ReSure. Your HSA will be invoiced $110 for such services after your first year.
  • LLC's Physical Address
  • Successor Manager - recommended, not required
  • Payment Authorization Form
  • $0.00
  • Nature of Our Services to You
  • Your typed name above constitutes a signature.
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