Introduction

You want to open a MyHSA Health Savings Account ("MyHSA") at Alliance Benefit Group of Illinois, Inc. ("Alliance"). Your participation in the MyHSA program is conditioned on your acceptance of certain terms, which are identified below. Please read carefully before proceeding. Additional information is available through certain web links identified below, or by calling the MyHSA Help Desk at 800-57 MyHSA (800-576-9472). The MyHSA program is made available pursuant to an agreement between Alliance Benefit Group of Illinois, Inc. ("Alliance"), Alta Trust and The Charles Schwab Bank ("CSB").

Use of Electronic Records

An "electronic record" means a record created, generated, sent, communicated, received or stored by electronic means. A "record" means any information that is inscribed on a tangible medium or stored in an electronic or other medium and is retrievable in perceivable form.

Participation in the MyHSA program is conditioned, in part, on your consent to have records provided or made available to you in connection with the MyHSA program in electronic form. By submitting this application, you hereby consent to receive electronic records.

Your consent to receive records in electronic form applies to all records that may be provided or made available at any time in connection with the MyHSA program, including but not limited to account statements, transaction records, fund prospectuses and annual reports.

You may withdraw that consent at any time. However, in such event Alliance Benefit Group of Illinois, Inc. has the right to terminate your participation and require that you liquidate your MyHSA account and have your funds returned to you at the address on record. In order to withdraw your consent to receive electronic records or to provide updated information on how Alliance Benefit Group can contact you electronically, you must contact us by telephone at 800-57 MyHSA (800-576-9472).

In addition to your consent to receive Electronic Records, you must acknowledge below each of the following terms and conditions. NOTE: Your participation in the Program is conditioned on your acknowledgement of each of these terms.

1. MyHSA Health Savings Account Custodial Agreement. You have read and you agree to the terms of the MyHSA Health Savings Account Custodial Agreement before you can enroll in the Program. The Custodial Agreement describes the rights and obligations of you, ABG, Alta Trust and Schwab Bank with respect to your HSA. You will find the Custodial Agreement at www.myhsa.com under Forms.
2. MyHSA Health Savings Account participant Fee Schedule. You have read and agree to the terms of the MyHSA Health Savings Account Fee Schedule before you can enroll in the Program. You will find the Fee Schedule at www.myhsa.com under Forms tab.
3. Alliance's Investment Policy Statement. You have read the Investment Policy Statement. You can find the investment policy statement at www.myhsa.com under Forms tab.
4. Alliance's Privacy Policy with respect to use of your personal information. You have read the Privacy Policy. You can find the privacy policy at www.myhsa.com under Forms tab.
5. Investment Prospectuses: You have read the prospectuses or prospectus profiles relating to the applicable Investment Options. You can find the prospectuses or profiles at www.myhsa.com under HSA tab/MyHSA Investment Options.

I have read and agree to the terms of the ABG MyHSA Health Savings Account
I do not agree to the terms of the ABG MyHSA Health Savings Account
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