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Withdrawal Card Request Form
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Name: ________________________________________________________
Address: ______________________________________________________
_____________________________________________________________
Phone (_______) ________________________________________________
Company you last worked for ___________________________________
Last Day Worked _______________________________________________
Reason you are no longer working: (Quit, layoff, resigned, Terminated, Retired):
______________________________________________________________________
There is NO fee for the withdrawal card. However, your Union Dues and Initiation must be paid up to date in order to receive a withdrawal card.
Print out and Mail this completed form to:
Teamsters Local 436
6051 Carey Drive
Valley View, Ohio 44125
Any questions, please call the Union Office at
Phone: 216-328-1833 or 800-506-4360
Fax: 216-328-1513
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