Louisiana: Become a Business Partner V2

Employee Information

Contact Person*

First Name

Last Name

Email*

Phone*

Organization Information

Job Title/Position*

Company/Association Name*

Industry*

Company Website*

Physical Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Number of Employees/Members*

Please include all staff (full-time, part-time, seasonal, etc.)

Number of Miles from Nearest Branch*

Company/Association Logo*

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Is your mailing address different from your physical address?*

Yes No

Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Are you the employee benefits contact for your company?*

Yes No

Employee Benefits Contact Information

Employee Benefits Contact Name

First Name

Last Name

Phone Number

Additional Information

As a partner of Louisiana FCU, you will be assigned a dedicated contact who will help you and your employees become familiar with Louisiana FCU and the ways we can help with financial goals and life challenges.

Within the next 30 days, when can we schedule a meet and greet?*

Additional Comments

Authorization

Your Signature*

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