Secure Home Banking Enrollment Form

1626 17th Street, Lewiston, ID  83501
Phone: (208) 746-7233 • Fax: (208) 746-0426

Member Information
You MUST currently be a Lewis Clark Credit Union member to complete this form!
The information requested below is for the primary member on the account.

Member Account Number:

First Name:

Middle Name/Initial:

Last Name:

Last 4 Digits Of Social Security #:

Birthdate (MM/DD/YYYY):

Email Address:

Street Address:



Zip Code:

Home Phone #:

Cell Phone #:

Work Phone #


Submit Form

By submitting this request, I acknowledge that I have read and agree to the terms of the Home Banking Disclosure