TEAMSTERS LOCAL 763

WITHDRAWAL FORM (non-mandatory)

First Name

Last Name

I request and authorize Teamsters Local 763 to issue me a withdrawal card for each month I have no reported hours worked. I understand, by signing below, I may not be eligible for Teamsters benefits.

Signature

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

Date

* Required Fields

TEAMSTERS LOCAL 763

14675 Interurban Ave S, Ste 305
Tukwila, WA 98168
206-441-0763