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.

Your Plan Number is a 5-digit number. If you do not know your plan number please call 800-917-4369 for assistance.

If you need help finding your Division Code, please contact your corporate office for assistance.
User Profile Information

E-mail addresses must be user specific. Group e-mail boxes are not permitted.