Star One Credit Union - Apply Now - Other Applications & Forms - IRA Contribution Form

First Time User

Maintenance Schedule

Apply Now

Home > Apply Now > Other Applications & Forms > IRA Contribution Form - ESA

You can submit this form electronically in Online Banking. Log in and click on the "Online Forms" tab and then click on the name of the desired application or form. Some "Online Forms" are partially auto-populated for your convenience.

Star One Coverdell Education Savings Account (ESA) Contribution Form

Please complete, print, sign, and mail to: Star One Credit Union, PO Box 3643, Sunnyvale, CA 94088-3643.
You may also fax your completed form to (408) 543-5203.

Designated Beneficiary's Information
Minor's Name
Birth Date		ESA Account Number

Contributor's Information
Contributor's Name
Street Address
City, State, Zip
Telephone Number
Social Security Number		Relationship to Minor

Contribution Information
Deposit Amount	$
Contribution for Tax Year		Contribution Date

Deposit Instructions
Cash/Check Deposit	$
or Transfer from Account	#

Signature
I certify the information contained in this form to be correct and I have not exceeded the total contribution limit allowable by federal tax regulations to the ESA or the tax year stated above. I certify that the deposit described above is eligible to be contributed to the ESA and I authorize the deposit in the manner described above. I certify that all of the information provided by me is correct and may be relied upon by the Custodian and the ESA Responsible Individual.
__________________________________________	_________________________________
(Contributor)	(Date)