Common Contracts
1 similar Eft Authorization Agreement contracts
ContractEft Authorization Agreement • August 11th, 2021
WEA ESP Pre-retired Dues115 East 22nd Street, Cheyenne, WY 82001FAX: 307-778-8161 Phone: 307-634-7991 ext. 102 Email: lbottom@wyoea.org EFT Authorization Agreement for Prearranged Payment of Dues FormNOTE: ESP Pre-retired dues are only paid once in a lifetime!Local Name: _Name: SSN4 (last four digits only): Address: Cell Phone: City State Zip: Home Email: Work Location (building name): OPTION 1: EFT Account pulling from:Membership Type/Fund/Obligations: □ Checking or □ Savings Fund Name Membership Type Annual Dues This EFT authorization will not be accepted unless a voided personal check is attached. NEA ESP Pre-retired - RT-9-6 $180.00 WEA ESP Pre-retired - RT-9-6 $ 50.00 LEA ESP Pre-retired – RT-9-6 $ 50.00 Total Obligation $280.00 • Total amount due can be divided into 2-6 payments,provided the total obligation is paid in full no later than July 10th.• Deductions
