MONTHLY AUTOMATIC PAYMENT

You have the option of setting up a monthly AUTOMATIC
payment PLAN or making a one-time only payment

THIS IS ONLY FOR PAYING UNION DUES, NOT HEALTH FUND PAYMENTS.
 


Amount to be Deducted Monthly



Member's Full Name



Local 11 Membership ID Number



Work Place / Department




Please do not use "$" when you write the amount to be deducted.
If you are having tecnical issues making payments, please call
the Dues Department during office hours at (213) 481-8530 Ext 341.