ER-DB-020

Service Credit Purchase Request

Employer Use ONLY
This form is for employer HR contacts use only. Participants, please see your employer for assistance.

* = required field

Participant Information
First Name*
Middle Initial
Last Name*
Last 4 of SSN*
Employer Information
Municipality Name*
Don't see your Municipality listed? Please contact MERS.
Employer HR Contact’s Name*
First Last
Employer HR Contact's Email*

Purchase documents will be provided electronically to the designated HR Employer Contact.
Service Credit
Amount of service requested in years and months or, the maximum dollar amount to be spent*
Years / months or dollar amount
Samples: 4 years 2 months, or $7,000
Participant Annual Salary
Enter the participant's annual salary only if they have less than 12 months of service (example: 33,000).
Type of service credit to be purchased*
- Generic
- Other Governmental
- Military
Note: Please provide a completed copy of Form F-27, Verification for the Crediting of Other Governmental Service. (MERS Fax: 517.703.9706)
Note: MERS enrollment must predate 7/1/1997 to purchase military time. Please provide a copy of DD-214 Military Discharge papers. (MERS Fax: 517.703.9706)
Is participant expected to work until eligible to retire?*
- Yes
- No
Provide pending termination date*
MM slash DD slash YYYY