Bulenox LLC Withdrawal Information Form

Bulenox LLC Withdrawal Information Form
Please complete the withdrawal information form for future Withdrawals. The name and address must match the Master Account agreement.

*Please resubmit the form If any of the personal information will be changed in the future.
Name*

First NameLast Name
Company
(Optional)
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Email*
example@example.com
BX ID*
Please Attach:

1. Copy of government-issued ID (DL or Passport)

2. W-9 (US traders) or W-8BEN (Non-US Traders)

Note* Payments can not be made to a C-corp, S-corp, or multiple-member LLC.
Cancelof
Please choose Preferred Method of Withdrawal:

Withdrawal could be requested via: Paypal, WISE, ACH, Wire Transfer, Venmo
1. PayPal Email Payout
2. ACH Transfer (United States Bank, Wise) Payout

Name of Bank

Bank Routing Number

Account NumberState / Province

Postal / Zip Code
3. Wire Transfer (International) Payout

Account Number

Routing Number/ International SWIFT (Bank SWIFT only)

Street AddressCity

Postal/ Zip CodeCountry
4. Crypto USDT Wallet
Limit $2000 per payout and $3000 per month
4. Venmo Payout
Email or phone number
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Please choose Preferred Method of Withdrawal: