After you complete this form, click Print-friendly for a printable version, sign it, and return it to GCI via email along with a copy of a valid identification.

This form may be scanned and emailed to [email protected]. Please be sure that you have completed all fields, including contact information and signature. Withdrawal forms that are not fully completed, submitted online and also signed and emailed to us will not be processed.

Forms submitted with missing information are subject to delay.

Funds are returned to the originating account in the following order:

  1. eCash
  2. Wire Transfer

Wire Payment

Other eCash