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Forms

These forms are being provided for your convenience. The forms are in printable formats and may be mailed to us at:

The Bancorp - Wealthcare
409 Silverside Road, Suite 105
Wilmington, DE 19809

If you have any questions, please call us at 866.271.9995 or email us at yourhsa@thebancorp.com.

ACH Transfer
In lieu of a paper ACH request, you may utilize our online Funds Transfer functionality to make a one-time or recurring electronic money transfer between your account with us and your account at another financial institution.

Affidavit of Unauthorized ACH
This form will allow a customer to dispute an Automated Clearing House transaction on their account. Please complete the form, sign and submit to The Bancorp Bank for further processing through mail or fax.

Change of Contact Information
This form can be used to update your name, e-mail address, telephone number, and home address information.

Corporate Resolution of Authority
This form, approved by the board of directors of a corporation, specifies which individuals are to be permitted to transact banking business on behalf of the company. This must be completed each time signers change and must be signed and submitted to The Bancorp Bank for further processing by mail.

Direct Deposit/Payroll Deduction Form For HSA Account Holders
This form allows an employer, or other organization to establish direct deposit into a checking and/or savings account that you have selected. Please print this form and provide to your employer or other organization. They will complete the form and set up your funds to auto transfer into your account.

Fictitious Name Certificate
This form is to be completed by a person who has a sole proprietorship business whose business name does not clearly state who the sole proprietor is. For example, John Smith has a business that is named "Antique Heaven." This business name does not clearly state that John Smith is the owner and therefore, a Fictitious Name Certificate must be completed. Please print, complete, sign and submit the form to The Bancorp Bank for further processing.

Health Savings Account (HSA) Contribution / Refund Deposit Slip
This form is used when depositing a refund check to your HSA or mailing in an HSA contribution.

Health Savings Account (HSA) Transfer/Rollover Form
Use this form to instruct The Bancorp Bank to transfer or rollover your Health Savings Account at another institution to a new account at The Bancorp Bank .

Health Savings Account (HSA) Employer Contribution Form
With this form an employer can make an initial deposit on behalf of multiple Health Savings Accounts for its employees.

Health Saving Account(HSA) Individual Contribution Correct Form
Please complete this form to report and correct an excess contribution to your Health Savings Account made during the current tax year.

Internal Funds Transfer Request
By completing this form, you authorize The Bancorp Bank to make a one-time money transfer between accounts at The Bancorp Bank . Only an authorized signer or account owner of the account from which funds are being transferred may initiate the request.

Internal Funds Transfer Request - Multiple Transfers
By completing this form, you authorize The Bancorp Bank to make multiple one-time transfers between accounts at The Bancorp Bank. Only an authorized signer or account owner of the account from which funds are being transferred may initiate the request.

IRA to HSA Transfer Form
Use this form to instruct The Bancorp Bank to transfer or rollover your IRA at another institution to an HSA account at The Bancorp Bank.

Limited Liability Resolution of Authority
This form allows an LLC to establish which individuals are to be permitted to transact banking business on behalf of the company. This must be completed each time signers change and must be signed and submitted to The Bancorp Bank for further processing by mail.

Limited Partnership Resolution of Authority
This form allows an LP to establish which individuals are to be permitted to transact banking business on behalf of the company. This must be completed each time signers change and must be signed and submitted to The Bancorp Bank for further processing by mail.

Medical Savings Account (MSA) Transfer/Rollover Form
Use this form to instruct The Bancorp Bank to transfer or rollover your Medical Savings Account at another institution to a new account at The Bancorp Bank.

Power of Attorney
This form allows a customer to designate another person to manage their account(s) at The Bancorp Bank. This person will have complete control of the account(s), however the power of attorney ceases to be recognized by The Bancorp Bank upon death of the accountholder. Please print, sign, notarize and submit this form to The Bancorp Bank for further processing by mail.

Remove Account Signer Request
Use this form to remove an authorized signer from your account.

Resolution for Facsimile
This form will allow a signer on an account to use a stamp on checks and other documents for their signature instead of hand signing the document. A color stamp must be used to deter fraud. Please print, hand sign, facsimile stamp the form and submit to The Bancorp Bank for further processing. Facsimile signatures will not be accepted by us without this completed form.

Stop Payment
This form allows for a customer to stop the payment of a check or ACH on an account. Please call the toll-free number listed in the customer service tab to place the stop payment. A stop payment is only valid for 14 days without this signed and submitted form. Once the form is received by The Bancorp Bank the stop payment will be valid for 6 months.

Wire Request Form for Deposit Accounts (Domestic)
Complete this form to transfer funds by wire to another U.S. bank.
Note: If you are wiring funds from a business or trust account, or if you have an individual/joint account and want to authorize a third party, such as a financial professional, to send wires on your behalf, a completed Wire Transfer Agreement (see form below) must be on file with the Bank.

Wire Request Form for Deposit Accounts (International)
Complete this form to transfer funds by wire to a non-U.S. bank.
Note: If you are wiring funds from a business or trust account, or if you have an individual/joint account and want to authorize a third party, such as a financial professional, to send wires on your behalf, a completed Wire Transfer Agreement (see form below) must be on file with the Bank. For international wire transfer requests initiated by a consumer (individual/joint account), you will have 30 minutes to cancel your request after you have been sent a disclosure indicating fees that may be assessed, and the exchange rate (if applicable).

Wire Transfer Agreement Form
In order for businesses and trusts to transfer funds by wire to another bank, this form must be on file with the Bank. Please complete and return the form to the Bank, before you initiate your first wire transfer (return contact information is provided on the last page of the agreement; you only need to complete the form once). From the date we receive your completed form, please allow at least two business days before initiating your first wire transfer. A Caller ID and PIN number will be issued to each authorized representative in order to initiate a wire transfer via fax, email, or telephone. Please allow up to ten business days for our mailing and your return of the PIN Acknowledgement Form. 

Note: Those with individual/joint accounts should not complete this form, unless to provide authorization of a third party, such as a financial professional, to send wires on your behalf.

Wire Instructions - Incoming
For an incoming wire transfer to your The Bancorp Bank account from a U.S. or non-U.S. bank.

Wire Instructions - Outgoing
For an outgoing wire transfer from your The Bancorp Bank account to a U.S. or non-U.S. bank.

W-8BEN Form
This form must be completed by a non-U.S. resident or business owner who does not have a U.S. Social Security Number (SSN) or Tax Identification Number (TIN).