National Retail Inventory Rebate Information Request

Payment Withdrawal For Your Inventory Rebate Program

Please note that withdrawals must be submitted in the last 1-3 days of each month. Withdrawal requests will be considered, approved and sent as requested below prior to the 6th day of the following month.
Name*
E-mail*
example@example.com
Withdraw from which account:
Desired Withdrawal Method
Coin Type
Desired Withdrawal Amount
BANK INFORMATION

NOTE: If your desired method of withdrawal is ACH or Wire please complete the following information.
Bank Name
Checking Account Number
ACH Routing Number
Wire Routing Number
Exact Name on the Account
CRYPTOCURRENCY INFORMATION

NOTE: If your desired method of withdrawal is Cryptocurrencty please complete the following information.
Please provide your Bitcoin address (NOTE: Double check your address because once payment is sent and if to the wrong address funds may be lost.)
Should be Empty:

Payment Withdrawal For Your Inventory Rebate Program