Local No. 4 Authorization Card Submission Form

Complete the form below, add your signature, and tap Submit Authorization Card. A completed PDF will be emailed directly to Local No. 4. On a phone, the card is sent without automatically downloading a copy.

First, Middle, Last Names

Address

Street Address

City

State

Zip Code

These fields are combined into the PDF address line.

Classification/Job Title

Employer

Cell Phone

Last 4 Digits Of SSN

Date Signed

Signature

Leave the PDF signature field open for Acrobat. Use this for a digital signature, Acrobat stamp, or Acrobat Fill & Sign drawing. Draw a signature now and place it on the completed PDF. Upload a signature/stamp image and place it on the completed PDF.

For the easiest phone workflow, choose Draw a signature now, sign with your finger, and submit from this page. The completed PDF will be emailed directly to Local No. 4 without automatically downloading a copy to the phone. Use Download Completed PDF Only if you want a copy for your records. Acrobat certificate-based digital signatures can still be added later by leaving the PDF signature field open.

This page loads its blank PDF from a separate linked file in the same website folder. Submission is handled by the HTML page so it works on phones without relying on mobile PDF-viewer buttons. Phone submissions are emailed without forcing a PDF download. A member may still use Download Completed PDF Only to save a copy.