Fraternal Order of Police of Ohio, Inc.

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FOPOLC Authorization Dues

AUTHORIZATION FOR LABOR UNION DUES DEDUCTION
Fraternal Order of Police, Ohio Labor Council, Inc.
222 East Town Street, Columbus, Ohio, 43215-4611
800-FOP-OLCI (367-6524)

I, the undersigned, hereby authorize my employer to check off and deduct from my payroll an amount equal to dues, remitting directly to the FOP, Ohio Labor Council, Inc.

Employer:

First Name:

Last Name:

Home Address:

City, State:

, *

Postal Code:

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Mobile Phone:

Personal E-Mail:

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Department:

Signature:

Date:

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