Payroll Deduction Form Terms And Conditions

Terms And Conditions

I hereby authorize my employer to deduct from my salary the membership dues as established by the Southern States Police Benevolent Association Inc. I understand that this amount will be deducted until

1) revoked by me at any time upon 30 days written notice to the employer, or 2) termination of my employment.

I understand that dues are calculated by SSPBA and are subject to change periodically, and I therefore authorize the agency to adjust my payroll deduction as necessary. The deduction made pursuant to this authorization shall be transmitted to:

Southern States Police Benevolent Association, Inc.
155 Highway 42 S, McDonough, GA 30252-7636.

My signature hereon is authorization to release my Social Security number in reporting dues deductions.