Please fill out the following form to generate a printer-friendly Withdrawal Form. All fields are mandatory unless otherwise noted. Check withdrawals can only be made by clients residing in the United States of America or Canada.

NOTICE: Do not print this page. Fill out all applicable fields, and press the "PRINT WITHDRAWAL FORM" button at the end of this form.
Customer Information
Full Name:
Street Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Telephone Number:
Withdrawal Information
Trading Account ID Number:
Withdrawal Amount:
Beneficiary Name:
Close Account?: No, do not close my account Yes, please close my account
NOTE: Beneficiary must be the trading account owner.
Capital Market Services, International - Bermuda, Ltd trading account owner (or one of the joint account owners) only.
Capital Market Services, International - Bermuda, Ltd may not make or receive payments via a third party.
Withdrawal Type: Check (for USD withdrawal only) Wire Transfer
Your Bank Information
NOTE: Fill out this section only if you chose "Wire Transfer" above.
Account Number:
ABA Number or Swift Code:
Bank Name:
Bank Address:
If you do not know your bank information, please contact your bank to obtain it.
Intermediary Correspondent Bank Information
(If applicable. Contact your bank officer if unsure.)
Intermediary Account Number:
ABA Number or Swift Code:
Bank Name:
Bank Address:
Date: March 11, 2010 04:48:10 PM