Select Employee Group Enrollment
To join our SEG Family, please submit the information below
Company/Organization Name
*
Primary Contact
*
First Name
Last Name
Title
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Website
Number of Employees
*
Number of Locations
Which of our branches is most convenient for you?
*
Please Select
Main Branch
Alberta Branch
ARECU Montgomery Branch
BFG Branch
Brewton Branch
Carrollton Branch
Cherokee County BranchÂ
Demopolis Branch
Dothan Branch
Fayette Branch
Goodwater Branch
Gordo Branch
Hollis Crossroads Branch
Hwy 43 Branch
Lakeview Branch
Linden Branch
McIntosh Branch
Millbrook Branch
Mt Vernon Branch
Northport Branch
Rice Mine Branch
Roanoke Branch
Rockford Branch
Samson Branch
Sky East Branch
Sky West Branch
Taylorville Branch
Valley Branch
Wadley Branch
Does your company offer direct deposits?
*
Yes
No
No, but we are interested in this.
Would your company permit payroll inserts?
*
Yes
No
Maybe
Would your company permit quarterly site visits to inform, educate, open accounts, answer questions, etc.?
*
Yes
No
Maybe
Submit
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