Secure Online Account Enrollment Form
5675 Highway 18 West, Jackson MS
Phone: 601.922.7055  •  Fax: 601.922.3283

Member Account Number:
First Name: Middle Name/Initial: Last Name:
Street Address: City: State: Zip Code:
Home Phone #: Cell Phone #: Work Phone #
Last 4 Digits Of Social Security #: Birthdate (MM/DD/YYYY): Email Address:
Please make sure that the information in this form is the same as what you have provided the credit union. If you are unsure about what address or phone number is on file at JAFCU please contact a Home Banking representative at 601.922.7055 OPTION 3 for further assistance.