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Create A High Desert ESD 403(b) Plan Salary Reduction Agreement

Blank Salary Reduction Form

To get a Printable BLANK Salary Reduction Agreement, Don't enter any information in the form below, and click here:

Online Salary Reduction Agreement

By entering your information into the online form, below, and then clicking the Submit button you will generate a printable Salary Reduction Form which should be printed out, signed by you, and then submitted to High Desert ESD with documentation that you have established an account with each selected Vendor:

Your Information

Your Name, Address, and Contact information is required.

  • Name
  • Street Address
  • Apt, Suite, or Unit (if applicable)
  • City
  • State
  • Zip
  • Telephone (home or mobile)
  • Email
  • Social Security Number
  • Agent Name and Telephone (If Applicable)

Effective Dates

Enter your desired Begin date for this Agreement. The agreement will remain effective until a new Agreement is submitted.

  • Begin Date

Select the Appropriate Type of Agreement Below:

  • Replace/Override a Previous High Desert ESD 403(b) Plan Salary Reduction Agreement
  • Start/Initiate a Very First (new) High Desert ESD 403(b) Plan Salary Reduction Agreement
  • Cancel/Discontinue an Existing High Desert ESD 403(b) Plan Salary Reduction Agreement

Distribution Among Vendors

If selecting a new Vendor, you MUST include documentation that an account has been established with that Vendor. High Desert ESD allows you to contribute to a maximum of 3 different vendors. If Replacing/Overriding a Previous Salary Reduction Agreement or Starting/Initiating a New Salary Reduction Agreement, you must select at least one Vendor. Finally, if this is one of 10 forms to be submitted as a group to establish an Active Payroll Slot for a new Vendor, then select "Other" from the pull-down box and write in the Vendor Name on the printed version of the form (all 10 forms should be submitted to CCC).

$ Traditional Dollars per Paycheck
$ Roth Dollars per Paycheck

$ Traditional Dollars per Paycheck
$ Roth Dollars per Paycheck

$ Traditional Dollars per Paycheck
$ Roth Dollars per Paycheck

Clicking the button below will Generate a printable PDF form populated with the information entered above. You must still sign, date, and submit the form to your Employer: