Hometown Bank HSA Enrollment Disclosures

Thank you for applying for a Health Savings Account (HSA) at Hometown Bank. To make your application quick and easy, please have the following information available for both the employee and, if applicable, the Power of Attorney:

  • Social Security Number
  • Residential address information including telephone number
  • Driver's License or State-Issued ID
  • Birth Date

If you have any questions or concerns while completing the application, please feel free to contact the Bank’s HSA Administrator at (920) 922-1790 between the hours of 8:00am and 5:00pm Monday – Friday.


To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.


Regarding The Privacy Of Our Financial Information

FACTS What Does Hometown Bank Do With your Personal Information?
Why? Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some, but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.
How? The types of personal information we collect and share depend on the product or service you have with us. This information can include:
  • Social Security number and account balances
  • Payment History and Transaction History
  • Credit History and Checking Account Information
When you are no longer our customer, we continue to share your information as described in this notice.

Reasons we can share your personal information Does Hometown Bank Share? Can You Limit this sharing?
For our everyday business purposes, such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or to report to credit bureaus. Yes No
For our marketing purposes - to offer our products and services to you. Yes No
For joint marketing with other financial companies. No No
For our affiliates everyday business purposes - information about your transactions and experiences. No Yes
For our affiliates everyday business purposes - information about your credit worthiness. No Yes
For our affiliates to market to you. No Yes
For non-affiliates to market to you. No Yes

Questions?     Please call us at (877) 922-1790 or visit our website at htbwi.com
Who We Are
Who is providing this notice? Hometown Bank
What We Do
How does Hometown Bank protect my personal information? To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include stringent computer safeguards, secured files and secure buildings.
How does Hometown Bank collect my personal information? We collect your personal information, for example, when you:
  • *Open an account or deposit money
  • *Apply for a loan or make loan payments
  • *Use your debit card
Why can't I limit all sharing? Federal law gives you the right to limit only:
  • *Sharing for affiliates' everyday business purposes -information about your creditworthiness
  • *Affiliates from using your information to market to you.
  • *Sharing for non-affiliates to market to you.
State laws and individual companies may give you additional rights to limit sharing.
Affiliate Companies related by common ownership or control, they can be financial and non-financial companies:
  • * Hometown Mortgage and Finance, Inc.
Non-affiliates Companies not related by common ownership or control. They can be financial or non-financial. Hometown Bank does not share information with non-affiliated companies.
Joint Marketing A formal agreement between non-affiliated financial companies that together market financial products or services to you. Presently, Hometown Bank does not jointly market financial products.


No minimum balance requirement.

No monthly account maintenance or activity fees. (ATM withdrawals at non-Hometown Bank ATMs may be subject to surcharges.)

Free Check Card available.

Free Online Banking with Bill Payment and Check Images.

Free E-Statement (Paper Statement available for $5.00 per month fee)

Tiered Interest Rate. The Current HSA interest rates can be obtained by visiting our web site at www.htbwi.com.

Account Set Up Fee of $25.00

Account Closing Fee of $25.00

I have read and agree to the above terms and conditions