Umarkets WithdrawalRequest-CC Blank

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REQUEST FOR WITHDRAWAL

USER INFORMATION
Please fill in all required data clearly to let us complete the transfer as quick as possible. Send us filled
scanned copy of blank to: support@umarkets.com.
(Money transfer is possible only in dollars.)
Username: Phone number:

Full name (specified in account): Address:

TRANSFER AMOUNT
I WANT TO WITHDRAW:
AMOUNT, USD: AMOUNT IN WORDS:

I WANT TO WITHDRAW FUNDS ON MY CREDIT CARD


(You can only apply the card used to deposit account)
Account holder:

Account number:

CONFIRMATION
I confirm that my account balance of _________________ specified in my corporate account and in the
reports provided by the company website is totally correct for the current day.
IMPORTANT: The company will not be able to SIGNATURE:
transfer money before getting identity documents.

For internal use only
Financial department: Dealing center:

Maxi Services (Belize) Ltd


Page 1 35 New Road, P.O. Box 1708, Belize City, Belize, Central America.
Phone: +44 (203) 6958926

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