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)

  1. ________  Share (savings) account # __________________________________________________
  2. ________  I'd like to contribute $1 per quarter
  3. ________  I'd like to contribute more.  Please deduct $______________ from my account.

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

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)

  1. ________  Share (savings) account # __________________________________________________
  2. ________  I'd like to contribute $1 per quarter
  3. ________  I'd like to contribute more.  Please deduct $______________ from my account.

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

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)

  1. ________  Share (savings) account # __________________________________________________
  2. ________  I'd like to contribute $1 per quarter
  3. ________  I'd like to contribute more.  Please deduct $______________ from my account.

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

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)

  1. ________  Share (savings) account # __________________________________________________
  2. ________  I'd like to contribute $1 per quarter
  3. ________  I'd like to contribute more.  Please deduct $______________ from my account.

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,  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

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)

  1. ________  Share (savings) account # __________________________________________________
  2. ________  I'd like to contribute $1 per quarter
  3. ________  I'd like to contribute more.  Please deduct $______________ from my account.

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,  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

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)

  1. ________  Share (savings) account # __________________________________________________
  2. ________  I'd like to contribute $1 per quarter
  3. ________  I'd like to contribute more.  Please deduct $______________ from my account.

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,  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!