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Benefitsolved.com E-mail fsa benefitsolved.com 11-04 FSA Enrollment-Dir Deposit Emp wo s info Copyright 2004 Infinisource. Total Authorized Pre-Tax Salary Reductions Waiver of Participation in Health FSA and Dependent Care FSA. After careful consideration I have chosen not to participate in the FSAs for the current Plan Year. 9-552-412 TX Page 1 of 2 R082912 Z5222TX enrollmenT a Civil Union as defined in the Certificate. Choose One. I authorize Infinisource Inc. to initiate credit/debit...

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