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Home / Line of Business / Health / #3301 HSA Beneficiary Designation H (Imprinted)

#3301 HSA Beneficiary Designation H (Imprinted)

$0.95

Quantity Nonimprint Imprinted
1-49 $0.75 N/A
50-99 $0.68 $0.95
100-249 $0.65 $0.83
250-499 $0.53 $0.64
500-999 $0.44 $0.54
1,000-2,499 $0.32 $0.37
2,500-4,999 $0.29 $0.34
5,000-9,999 $0.26 $0.31
10,000 $0.25 $0.30
NOTE: Forms are available to be purchased individually, and there are no minimum quantity requirements.
Imprinting includes up to four lines of type – black ink.
Additional quantities are available at a reduced fee.
Minimum Qty: 50
  • Description

Description

#3301 HSA Beneficiary Designation H

  • Revokes or supplements prior designations
  • Identifies primary or contingent beneficiaries
  • Identifies the percentage share for each beneficiary
  • Provides for spousal consent for community or marital property states

Non-Imprinted

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