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Create A Estacada 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 Estacada 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 Estacada 403(b) Plan Salary Reduction Agreement
  • Start/Initiate a Very First (new) Estacada 403(b) Plan Salary Reduction Agreement
  • Cancel/Discontinue an Existing Estacada 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. Estacada 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

$ Traditional Dollars per Paycheck

$ Traditional 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: