Intermediary Bank Name: Intermediary Bank Address, City State, Zip Code & Information for Intermediary Bank Country Customer Signature: Date: Customer Signature: Date: Date: Customer Signature: Date: Customer Signature: We may either return deposits, checks and other items that we receive after your account is closed or we may reopen the account and accept a deposit or debit for you, even if doing so overdraws your account, without being liable to you. You agree to immediately pay all amounts you owe us. Bank use only In Person Email Mail Call Back If the Form is received by Email Customer signature(s) verified by: Caller: Spoke To: Time & Date: Signatures of bank officials: Name: Signature: Date: Name: Signature: Date: Name: Signature: Date: Account to be debited: Currency : USD, CNY, HKD Other: Amount to be debited: Applicable only if option 3 is selected : Credit less Charge Waived fee Account Closure Processed by: Date: Comment: X Account Closure Verified by: Date: Comment: X *Required field Please refer to Schedule of Fees for disbursement by Bank Check or Wire transfer If you choose to send us this application electronically, please email to in PDF version.
Intermediary Bank Name: Intermediary Bank Address, City State, Zip Code & Country Information for Intermediary Bank Customer Signature: Date: Customer Signature: Date: Customer Signature: Date: Customer Signature: Date: We may either return deposits, checks and other items that we receive after your account is closed or we may reopen the account and accept a deposit or debit for you, even if doing so overdraws your account, without being liable to you. You agree to immediately pay all amounts you owe us. Bank use only In Person Email Mail Call Back If the Form is received by Email Customer signature(s) verified by: Caller: Spoke To: Time & Date: Signatures of bank officials: Name: Signature: Date: Name: Signature: Date: Name: Signature: Date: Account to be debited: Currency : USD, CNY, HKD Other: Amount to be debited: Applicable only if option 3 is selected : Credit less Charge Waived fee Account Closure Processed by: X Date: Comment: Account Closure Verified by: X Date: Comment: *Required field Please refer to Schedule of Fees for disbursement by Bank Check or Wire transfer If you choose to send us this application electronically, please email to in PDF version.
21ad48d3-35dd-45c8-9df0-05e30fb1de46.docx