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Revoke Agreement

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					                                                     401 (k) Participant Change Form
                                                                (To Be Retained by Employer)



Name of Plan:    Kasco, Inc 401 (k) Profit Sharing Plan                  Plan ID #: IRK40417

Use this form to re-enter the plan or to change your payroll withholding amount.




1. Employee Information

           Participant Name:

           Social Security #:                                               Effective Date:




2. Salary Deferral Information

           I authorize my Employer to withhold from my wages each pay period an amount

           equal to:               %            or          $


           My employer agrees to withhold such amount and pay it to the Trustee for deposit to
           my retirement account.

           I have the right to change, amend, or otherwise revoke this agreement, in writing,
           subject to plan administration provisions.

           If this Agreement is revoked in its entirety, I waive my right to re-enter the plan until
           such time as I submit to the Employer an updated Participant Change Form.


           I hereby instuct my Employer to cease withholding from my wages beginning with the payroll
           period indicated - Effective for the payroll period




3. Signatures


           Employee Signature:                                                                   Date:____________


           Employer Signature:                                                                   Date:____________

				
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Description: Revoke Agreement document sample