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)

________________________________________________

________________________________________________

________________________________________________


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:
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