WITHDRAWAL REQUEST FORM  
 

23 College Hill, 3rd Floor
London EC4R 2RT
United Kingdom


FAX to: +44 (0) 207 236 4870

To withdraw funds or close an account, fully complete, print, and sign this Withdrawal Request form.

All information requested below must be provided to avoid errors or delays in processing. P.O. Boxes not accepted. FOREX.com will not be held responsible for delays caused by incorrect information provided by the customer.  

Withdrawal requests are typically processed within two (2) business days of receipt of this form. Please note that international wires may take several business days from the time the wire transfer is initiated to be posted to your bank account.



Method of Withdrawal:
Wire Transfer
Withdrawal Amount     
FOREX.com Account Information
Date (MM/DD/YYYY)
Customer Name *
Account #
Address Line 1*
Address Line 2
City, County, Country
Telephone Number
RECEIVING SOURCE INFORMATION
Bank Name *
ABA # or Swift Code
Bank Account # *
Name on Account
Bank Address
City, County, Country
ADDITIONAL INFORMATION REQUIRED FOR INTERNATIONAL TRANSFERS
US Intermediary Bank
US Intermediary Bank Address
Intermediary Bank ABA #
CHIPS UID #

*Customer and bank account information MUST match the information provided on your original account application. We will only wire funds to the bank account of record and/or to the original funding source. Under no circumstances will FOREX.com make or receive payment(s) via a third party.

Reason for Withdrawal
Customer Signature(required)  X                                                                    
Print and Sign the completed withdrawal request form.



FAX form to +44 (0) 207 236 4870

Thank you for choosing FOREX.com.