Apply for an Account

To expedite the application process, all forms should be completed and signed. Completed forms should be submitted by fax to 304-558-1324 or emailed to This email address is being protected from spambots. You need JavaScript enabled to view it..

Employers Initial Statement

Transfer Of Business

Benefits Reimbursement Agreement

Non-Profit Organization

Voluntary Coverage Form

Application For Establishment of a Joint Account

Refund Application