Teamsters Local 745

Withdrawal Card Request

First Name:

Middle Name:

Last Name:

Employer:

Last 4 SSN:

Telephone Number:

Your Street Address:

City, State:
,

Zip Code:

Last Day of Work:

Reason for Request:

Other (please explain):

Signature:

Use your mouse, finger, or touch device to write your signature.

By accepting a withdrawal card, you will not have to pay union dues during the time that you are not working. However, please remember that you will owe dues if you worked one or more days during a calendar month.

When you so return to Teamster work, you must immediately deposit your withdrawal card with the local you care applying to so that you will be a member in good standing.