Mail-in Withdrawal Request Form
WITHDRAWAL REQUEST FORM
Name: __________________________
Security Code: _________________________
Trader ID: ______________ (your login name)
Amount to Withdraw (write ALL to close account):_______________
Email Address: __________________________________________________
Home Address (this is where we will send your check)
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Signature: ___________________________________________
Date: _________________________________________________
Questions? Call 319-335-0881 or write to iem@uiowa.edu.
Mail your completed form to: IEM Administrator
W283 PBAB
University of Iowa
Iowa City, IA 52242
For office use only:_________ _________ _________ ________ id manager database check
