| TEAMSTERS LOCAL NO. 572 Withdrawal Card Form |
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| Withdrawal Card Form to print select File -> Print then chick -> Return to Menu | |
| NAME _______________________________________________________________________
SOCIAL SECURITY NUMBER ___________________________________________________ ADDRESS ___________________________________________________________________ CITY/STATE _________________________________________________________________ PHONE ( ________ ) _________________________________ |
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COMPANY: __________________________________________________________________
LAST DAY WORKED: _________________________________________________________
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| YOUR DUES MUST BE PAID UP TO DATE. YOU HAVE 90 DAYS FROM YOUR LAST DAY WORKED TO SUBMIT THIS FORM. |
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RESPECTFULLY SUBMITTED,
SIGNATURE___________________________________
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| DATE _____________________ TIME STAMP _________________________________ |
| Print out and mail or fax to: Local 572, 450 E. Carson Plaza, Suite A, Carson, CA, 90746 Fax: (310)515-0942 |