Withdrawal Card

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Withdrawal Card

Get a withdrawal card when you leave your Job. Be sure you request a withdrawal card when being laid-off, going on a leave of absence, lengthy medical leave, or terminating your employment. The charge for a withdrawal card is still only 50 cents but all initiation fees and back dues must be paid before the withdrawal card is issued.

Stop by the office and  complete the form below 

Please provide the following contact information:

First Name
Last Name
Middle Initial
S.S.No.
My Last Day Of Work
Name Of Employer
Reason For Leaving
 

 

and mail, or e-mail it to our office along with your check or money order for 50 cents. It is your responsibility to obtain a Withdrawal Card so please take care of it as soon as possible after leaving the company, so that you will not be obligated to pay extra dues. Failure to request a Withdrawal Card may cause you to pay back dues. 

Please provide the following contact information:

First Name
Last Name
Middle Initial
S.S.No.
My Last Day Of Work
Name Of Employer
Reason For Leaving

 


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