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Withdrawal Card Request

Complete the following information and hit submit to request a Withdrawal Card.

Date:
Name:
Last 4 of SS#:
Contact Number:
Email:
Employer:
Reason for Leaving:
Last Day of Work:

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Teamsters Local 179
1000 NE Frontage Rd Joliet, IL. 60431
Joliet, IL 60431
  815.741.2200

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