Payroll Deduction - Esignature
Social Security Number:
Address: , ,
Date of Employment:
I direct my employing agency to deduct from my wages the appropriate FLPBA dues in accordance with collective bargaining or other agreement between PBA and the agency, if available. This authority will remain in effect until such time as I provide 30 days written notice to FLPBA and the agency to terminate said deduction.
Each member who recruits another member may receive $25.00 from the Florida PBA!
Recruiter - Last 4 of SSN:
You agree your electronic signature, below, is the legal equivalent of your manual and/or handwritten signature on this Agreement. By signing electronically using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. My signature hereon is authorization to release my social security number when reporting dues deductions.
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Your legal name
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Document Name: Payroll Deduction - Esignature
Agree & Sign