E-Statement Application

E-Statement Enrollment Form

Please complete the information on this form to apply for access to your account information. All information is required in order to process your application.

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After you have completed the form, press the "Submit Application" button to send your application. Our website is protected by the VeriSign, an internet security provider.

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E-Statement Enrollment Form

I am signing up for

E-Statements
(electronic statements)

Required Field

Account #

Primary Owner

First Name

Last Name

Phone w/Area Code

Address

City

State

Zip Code

Email Address

All members with email addresses will receive information on special events and promotions sent straight to their email, unless they opt-out by checking this box.

Joint Owner
(check box and complete only if applicable)

First Name

Last Name

Phone w/Area Code

By typing my/our initials in the box below I/we agree that I/we have read the SELCCU Internet Services Disclosure and accept the terms.

Primary Owner Initials

Joint Owner Initials