Withdrawal Application - Wire Form

After you complete this form, click Print-friendly for a printable version, then print it and return it signed to GCI Financial. This form may be scanned and emailed to payments@gcitrading.com or faxed to any of our fax numbers available at http://www.gcitrading.com/fax.htm. GCI does not charge for sending wire payments, however transfer fees are applied by our remitting bank(s). Additionally, there may also be several intermediary banks who may charge for passing your funds along and unfortunately we have no control over those correspondent bank charges. This request will be processed within two business days of receipt of this form. Forms submitted with missing information are subject to delay.

Your GCI Account Information

Required fields are indicated with an asterisk (*).

Last Name*: Account Currency*: *
First Name*: Withdrawal Amount*:
Login Username*: Your E-mail*:
GCI Account Number*: Contact telephone number*:
   

Beneficiary Bank Information

Required fields are indicated with an asterisk (*).
Bank Name*: *
Address 1:
Address 2:
Country:
Swift Code*: *
Bank Code:

Beneficiary Account Information

Required fields are indicated with an asterisk (*).
Account Number*: *
Account Name*: *
Payment Currency*: * (Currency in which you wish to receive your funds.)
Additional Information:

Additional Information

Required fields are indicated with an asterisk (*).
Will you be closing your account?* *
Any comments on our service?