Star One Credit Union
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To submit this form electronically, log into Online Banking and select "IRA Contribution Form" in the "Online Forms" drop-down menu.

Star One IRA Deposit/Contribution Election Form

Use this form to make your annual contribution to your existing Star One Credit Union Traditional or Roth Contributory IRA.

Complete, print, sign, and mail this form to Star One Credit Union, P.O. Box 3643, Sunnyvale, CA, 94088-3643. You may also fax it to (408) 543-5203 Attn: IRA Services. Please complete a separate form for each IRA contribution.



IRA Acct. Holder Name

Receiving IRA Member Number

Today's Date

Cash/Check Deposit $

Transfer from Star One Acct. #

IRA Investment Acct. #
I wish to make a deposit to my IRA for the tax year in the amount of $ .
I certify the information contained in this form to be correct and I have not exceeded the combined total contribution limit allowable by the Federal Tax Regulations for my Traditional and/or Roth IRAs for the tax year stated above.

Signature of depositor or account holder

Teller initials ____ 
Date ________ Audited by ____ Date ________
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