Membership Application
PO Box 190
Caldwell, ID 83606-0190
(208) 454-4286
Submitted On:
First Name
Middle Initial
Last Name
Street Address
City
State
Zip Code
Date of Birth
(mm/dd/yyyy)
Phone #
Email Address
Social Security #
This is a secure application but if you are uncomfortable providing your SSN here you may call us with this info after submission. We cannot process your application without this information.
Driver's License #
DL State of Issue
Employer
Place of Birth (City, State)
Nationality
Interested in:
Savings
Checking
Certificates
Visa Debit Card
I consent to accept delivery of account documents electronically by Simplot Employees Credit Union.
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