Request for Simplified Contribution Platform Access
If you need assistance completing this form please call Fidelity Customer Support at 800-917-4369.
This form is used to request access to Fidelity's Simplified Contribution Platform for the purposes of submitting or viewing plan contributions.
Plan Number
Your Plan Number is a 5-digit number. If you do not know your plan number please call 800-917-4369 for assistance.
Division Code / Organization Identifier
If you need help finding your Division Code, please contact your corporate office for assistance.
User Profile Information
First Name
Last Name
Organization Name
Organization City
Organization State
Contact Phone Number
Contact e-mail Address
E-mail addresses must be user specific. Group e-mail boxes are not permitted.
Confirm Contact e-mail Address
Contact Information