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First Name *
Last Name *
Phone *
Email *
Last 4 digits of SS# *
Date of last day worked *
Request Reason *
Please list the reason of your Withdrawal request, i.e. Medical, FMLA, Resignation, Worker's Comp.
Your employer and location *

Other than paid time off, if you leave the industry or shop for any reason including Leave of Absence, you must request a withdrawal card within 90 days of your last day worked.  A withdrawal card will be issues provided all dues and financial obligations are paid and current; including dues for the month the withdrawal card is issued.  

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Teamsters Local 896
2050 Lincoln Ave
Pasadena, CA 91103

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