IBEW Local 41, Buffalo, NY

Vacation Withdrawl Request

Prior to filling out this form you have to contact the credit union at 716-662-6133 to get access to view your vacation account. Then check your vacation balance on the credit union website or on the credit union app on itunes or android to ensure the amount you are requesting is available. Finally, please proceed to fill out the form below and submit it to us. Thank you!

First name:

Last Name:

Phone Number:

Last 4 Social Security #:

Amount Requesting:

I have read the requirements above:

Enter the text shown in the image above.

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