Common Contracts

2 similar Transportation Fringe Benefit Plan contracts

ADMINISTRATION PROVIDED BY:Diversified GroupPO Box 299Marlborough, CT 06447860-295-0238 x 391Toll free 888-322-2524
Transportation Fringe Benefit Plan • October 20th, 2016

Mass Transit: I authorize my Employer to deduct $ /per pay for a total of $ / per month for a Mass Transit Account on a pre-tax basis from my paycheck up to a maximum of $255.00 per month.

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ADMINISTRATION PROVIDED BY:Diversified GroupPO Box 299Marlborough, CT 06447860-295-0238 x 391Toll free 888-322-2524
Transportation Fringe Benefit Plan • January 19th, 2016

Mass Transit: I authorize my Employer to deduct $ /per pay for a total of $ / per month for a Mass Transit Account on a pre-tax basis from my paycheck up to a maximum of $255.00 per month.

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