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					                                                                                                   ACM (USA) LLC
                                                                                                           th
                                                                                 575 Lexington Avenue, 30 Floor
                                                                                             New York, NY 10022
                                                                                              Tel: (212) 758-7200
                                                                                              Fax: (646) 308-9262
                                                                                 E-mail: operations@acmusa.com


                              ACM USA Account Withdrawal Form


       Select Account Type:
                      Individual       Joint          Business           Trust/IRA


       Client Account Info:
       Name:                                        Date:
       Account No.:                                 E-mail:


       Client Info:
                                                    Method of Withdrawal:
       Street:                                           Credit Card (No fee)*
       State/Province:                                   Wire Transfer ($25 dollar fee)
       Postal Code:                                 Check** :       Overnight ($20 dollar fee)
       Country:                                                     Regular Mail
                                                         Online Check (ACH)***


       Withdrawal Info:
       Amount:                                      Is the Account being closed?
       State/Province:                                 No        Yes If yes, please tell us why?

       Postal Code:
       Country:
       Phone:
       Email:


       Banking Information (For Clients Intending to Withdraw Funds via Wire):

       Bank Name:
       Address:
       Account#:                               Swift/ABA#:
       Bank Account Holder's Name:
       Bank Contact:




ACM (USA) LLC
                                                                                                               1
09-16-2008
                                                                                                                ACM (USA) LLC
                                                                                                                        th
                                                                                              575 Lexington Avenue, 30 Floor
                                                                                                          New York, NY 10022
                                                                                                           Tel: (212) 758-7200
                                                                                                           Fax: (646) 308-9262
                                                                                              E-mail: operations@acmusa.com




       Intermediary Bank Information (for INTERNATIONAL transfers):

        **THIS SECTION IS MANDATORY FOR ANY WIRES BEING TRANSFERRED
                      TO A NON-U.S. BASED BANK ACCOUNT**

       Bank Name:
       Address:
       Account#:                                   Swift/ABA#:
       Bank Account Holder's Name:
       Bank Contact:

The undersigned understands that this Form is a legally binding contract. The undersigned represents and warrants
that the information provided is true and correct. Furthermore, the undersigned agrees to notify ACM (USA) LLC
of any material changes in writing pursuant to the Client Agreement. ACM (USA) LLC may, in its sole discretion,
verify the accuracy of this information but is under no obligation to do so. Please allow 2-3 business days for your
request to be processed.

Primary Client Signature                 Date                      Print Name




Joint Client Signature (if applicable)   Date                      Print Name




*Withdrawals to credit cards may only be made up to the amount that was charged to the credit card when funding
the account. Any excess amounts will be refunded via check or wire transfer.

**Checks will only be made payable to the name of the Account holder.

***Online Checks (ACH) will only be made payable to the name of the Account Holder. You may only use this
option if you funded your account with an ACH.




ACM (USA) LLC
                                                                                                                            2
09-16-2008

				
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