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WEAC Support Staff Electronic Transfer

WEAC Support Staff Electronic Transfer

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Published by despa
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Categories:Types, Research
Published by: despa on Jun 04, 2013
Copyright:Attribution Non-commercial

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06/28/2014

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WISCONSINEDUCATIONASSNCOUNCIL
Support
Staff
Association
2013-2014
o
I
choose
ELECTRONICFUNDSTRANSFERName:
HomePhone:
WorkLocation
Name:
Member
ID:
Address:
City,State
Zip:
AlternatePhone:Home
Email:
AlternateEmail:
-,
CheckNumber
,
.'.
.
.'
._
I
AccountNumber
--
-.,.
~
-<
••
-
_
_
".__
O'.~'
.
.
,,:_~_
".'
c_
I
Routing
Number
.......
.
h.
~
':
-
.
,:.
-
.:-
,
-----
_
.,
--
$5
$72
$15
$10$187
$110.5
LocalDues
WEACPAC
WEACDues
Membership
Type/Fund/Obligation:
NEA:AC-2-100SEA:AC-2-100 LEA:AC-2-100
Electronic
Funds
Transfer
-
Bank
DraftAuthorization
OutstandinBalance:
$
399.50#
of
Deductions:
12
DeductionAmount:
$33.29
BankName:AccountType:
D
Checking
.
D
SavingsBankRoutingNumber(9digits):BankAccountNumber:PLEASE
ATIACH
AVOIDEDCHECKTOTHISFORMSignature:
Date:
**
LEGAL
DISCLAIMERLANGUAGE
IS
LOCATED
ON
THE
REVERSE
SIDEOF
THIS
FORM

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