Deduct-A-Buck Member Enrollment Form
YES! I want to preserve my right to choose
a credit union
Please deduct my contribution as follows: (select one choice from each
numbered item)
- ________ Share (savings) account # __________________________________________________
- ________ I'd like to contribute $1 per quarter
- ________ I'd like to contribute more. Please deduct $______________ from my account.
Name: _____________________________________________ Occupation: ________________________
Employer: ______________________________________________________________________________
Signature:
__________________________________________ Date:
______________________________ YES! I want to preserve my right to choose
a credit union Name:
_____________________________________________ Occupation:
________________________ Employer:
______________________________________________________________________________ Signature:
__________________________________________ Date:
______________________________ YES! I want to preserve my right to choose
a credit union Name:
_____________________________________________ Occupation:
________________________ Employer:
______________________________________________________________________________ Signature:
__________________________________________ Date:
______________________________ YES! I want to preserve my right to choose
a credit union Name:
_____________________________________________ Occupation:
________________________ Employer:
______________________________________________________________________________ Signature:
__________________________________________ Date:
______________________________ YES! I want to preserve my right to choose
a credit union Name:
_____________________________________________ Occupation:
________________________ Employer:
______________________________________________________________________________ Signature:
__________________________________________ Date:
______________________________ YES! I want to preserve my right to choose
a credit union Name:
_____________________________________________ Occupation:
________________________ Employer:
______________________________________________________________________________ Signature:
__________________________________________ Date:
______________________________
The above information is required by the Federal Election
Committee. Your contributions must be voluntary. You have the
right to refuse to contribute without fear of reprisal. Your
contributions are not deductible for federal or state income tax
purposes">
Deduct-A-Buck Member Enrollment Form
Please deduct my contribution as follows: (select one choice from each
numbered item)
The above information is required by the Federal Election
Committee. Your contributions must be voluntary. You have the
right to refuse to contribute without fear of reprisal. Your
contributions are not deductible for federal or state income tax
purposes">
Deduct-A-Buck Member Enrollment Form
Please deduct my contribution as follows: (select one choice from each
numbered item)
The above information is required by the Federal Election
Committee. Your contributions must be voluntary. You have the
right to refuse to contribute without fear of reprisal. Your
contributions are not deductible for federal or state income tax
purposes">
Deduct-A-Buck Member Enrollment Form
Please deduct my contribution as follows: (select one choice from each
numbered item)
The above information is required by the Federal Election
Committee. Your contributions must be voluntary. You have the
right to refuse to contribute without fear of reprisal. Your
contributions are not deductible for federal or state income tax
purposes, Your credit union is prohibited from reimbursing you for
your political contribution.
Your contribution will be noted on your account statement as
"Pol Acct." You may cancel at anytime by notifying your
credit union. Please complete this form and send it to your credit
union. THANK YOU!
Deduct-A-Buck Member Enrollment Form
Please deduct my contribution as follows: (select one choice from each
numbered item)
The above information is required by the Federal Election
Committee. Your contributions must be voluntary. You have the
right to refuse to contribute without fear of reprisal. Your
contributions are not deductible for federal or state income tax
purposes, Your credit union is prohibited from reimbursing you for
your political contribution.
Your contribution will be noted on your account statement as
"Pol Acct." You may cancel at anytime by notifying your
credit union. Please complete this form and send it to your credit
union. THANK YOU!
Deduct-A-Buck Member Enrollment Form
Please deduct my contribution as follows: (select one choice from each
numbered item)
The above information is required by the Federal Election
Committee. Your contributions must be voluntary. You have the
right to refuse to contribute without fear of reprisal. Your
contributions are not deductible for federal or state income tax
purposes, Your credit union is prohibited from reimbursing you for
your political contribution.
Your contribution will be noted on your account statement as
"Pol Acct." You may cancel at anytime by notifying your
credit union. Please complete this form and send it to your credit
union. THANK YOU!