Description
#3322 Qualified HSA Funding Distribution Request H
- Requests the direct movement of Traditional or Roth IRA assets to an HSA
- Contains complete eligibility rules
#3322 Qualified HSA Funding Distribution Request 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. | ||
