Interested in
having your dues come out of your paycheck?
If so, please fill out
this authorization form, mail it back in the enclosed envelope, and we will
start billing your company for your dues.*
It’s that easy!
UFCW Local
555
Employee’s
Authorization for Payroll Deductions
to be
remitted to
United Food
& Commercial Workers Union Local 555
To: Any Employer under
contract with United Food & Commercial Workers Union Local 555
You are hereby authorized and directed to deduct from my
wages, commencing with the next payroll period, all Union dues and initiation
fees that shall be certified by the Secretary-Treasurer of Local 555 of the
United Food & Commercial Workers International Union, and to remit same to
the said Secretary-Treasurer.
This authorization and assignment is voluntarily made in
consideration for the cost of representation and collective bargaining and
other activities undertaken by the Union and is not contingent upon my present
or future membership in the
This authorization and assignment shall be irrevocable
for a period of one (1) year from the date of execution or until the
termination date of the agreement between the Employer and Local 555, whichever
occurs sooner, and from year to year thereafter, unless not less than thirty
(30) days and not more than forty-five (45) days prior to the end of any
subsequent yearly period I give the Employer and the Union written notice of
revocation bearing my signature thereto.
The Secretary-Treasurer of Local 555 is authorized to deposit
this authorization with any Employer under contract with Local 555 and is
further authorized to transfer this authorization to any other Employer under
contract with Local 555 in the event that I should change employment.
Initiation fees and dues must be paid in full in order to
be eligible for the membership death benefit, and/or withdrawal card.
* some people
may not qualify for payroll deduction because of garnishments, other deductions
from their paychecks, or low hours.
_________________________ _________________________ __________________________
Employee Name
(please print) Social Security # Name of Employer
________________________ _________________________
Employee’s
Signature Date Signed
