Withdrawal Card Request Form

Need a withdrawal card? Simple! Just fill out the form below or send an email to wcards@ufcw1500.org with your name, last date you worked, and a message stating you are requesting a withdrawal card, and we'll let you know when we send it out to you!

First Name

Last Name

Member ID#

Your UFCW Member ID# (OK if you don't have it handy)

Company

The company you work for

Store #

Last Date You Worked:*

Please type the month, date and year

Phone Number

Address 1

Address 2

City

State

Zip

Request:*

Please state you are requesting a withdrawal card from UFCW Local 1500

Please check the box to authorize your request of a Withdrawal Card

By checking this box I hereby acknowledge and state that I am requesting a Withdrawal Card from United Food and Commercial Workers Local 1500*

Email Address