| TEAMSTERS LOCAL NO. 63 Withdrawal Card Form |
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| Withdrawal Card Form to print select File -> Print then chick | |
| 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: 845 Oak Park Road., Covina, CA 91724 (626) 859-4084 Fax or 379 W. Valley Blvd. Rialto, CA 92376 (909) 877-2452 Fax |