Sample Contribution Remittance Form
Contribution Remittance Form
|The Rabbis and Cantors |[pic] |Fidelity Investments |
|Retirement Plan | |P.O. Box 770002 |
|Client Number – 19000 | |Cincinnati, Ohio 45277-0089 |
|PARTICIPANT INFORMATION |EMPLOYEE | EMPLOYER |
| |PRE-TAX |CONTRIBUTION |
| | | |
|SOCIAL SECURITY |LAST NAME |FIRST NAME |AMOUNT |AMOUNT |
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| | |Source Total | | |
|Please: | |
|Make checks payable to FMTC. |Enter Total |
|Include your client number (19000) on your check. |Contribution Amount: |
|For information regarding your Program, please call your Client Services Team at: | |
|1-800-343-0860 Monday - Friday 8 a.m. - 7 p.m. Eastern Time. | |
| | | | |
|Remittance Prepared by: | | |$ ____________________ |
| | | | |
|Division Code: | | | |
| | | | |X | |
| | | | | |Check |
|Daytime Phone: | | | | | |
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| | | | | | | | |
|Contribution Year: |20 | | | | | | |
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(Investments will be recorded as current year contributions unless otherwise indicated.)
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