Star One Credit Union
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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.

TRADITIONAL

 
ROTH

 
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
FOR CU USE ONLY

Teller initials ____ 
Date ________ Audited by ____ Date ________
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