Deposit-Withdrawal Request Form

1

What's your name?* This field is required.

First Name

Last Name

2

What's your mobile phone number?* This field is required.

3

What's your email address?* This field is required.

example@example.com

4

Which one of your investment accounts are you requesting for?* This field is required.

5

Are you requesting a deposit or a withdrawal?* This field is required.

Deposit

Withdrawal

6

Will this be a one-time or a recurring?* This field is required.

One-Time

Recurring

7

How much do you want to deposit?

8

How much do you want to withdraw?

9

When would you like this one-time deposit to take place?

Date

10

From which bank will this one-time deposit come from?Institution Name Only

11

Which day of the month would you like to schedule your recurring deposit?

1st

5th

15th

20th

12

From which bank will this recurring deposit come from?Institution Name Only

13

When would you like this one-time withdrawal to take place?

Date

14

To which bank will this one-time withdrawal be sent?Institution Name Only

15

Which day of the month would you like to schedule the recurring withdrawal?

1st

5th

15th

20th

16

To which bank will this recurring withdrawal be sent?Institution Name Only

17

Would you like to withhold federal/state taxes on the withdrawal?

YESNO

19

Which % of state tax would you like withheld?

5%

7%

10%

State Minimum

20

Please upload a picture of a voided check from your bank account (to be used for the deposit/withdrawal):

Drag and drop files here

Select files to upload

Max. file size: 10.6MB