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SEG Enrollment Form

Interested in adding to Louviers Federal Credit Union’s Field of Membership?

If you are interested in having your company added to Louviers Federal Credit Union's Field of Membership, please provide the following information.

Date

YYYY

Name

First Name

Last Name

Title

Company Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Number of Employees

Distance from Louviers Federal Credit Union

Field of Membership (all employees, employees in particular office, employees and volunteers, etc.)

Additional Remarks

Acknowledgement

I certify the above information is correct to the best of my knowledge and that I have signing authority for this company or organization.