A different form is coming soon. For now, please download the following PDF.

Please fill it out, and send it back to us using any of the following methods:

  1. Email a scanned copy to credit@valleywidecoop.com
  2. Fax to (208) 372-7011
  3. Mail it to PO Box 459 Rexburg, Idaho 83440

Page 1 is required. Page 2 is only required if you are applying for more than $7,500 worth of credit, and page 3 is optional.