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  CHINESE
     

Withdraw Application

Note: Please make sure that your withdraw bank account information is the same with which you submited to COOPER BANK. If you want to use another account, please click here to apply to change your bank account information.
* Name:
 (Input Your full name here; Ex: DAVID COOPER)
* Gender:：
 (please choose your gender.)
* Date of Birth:
Year Day(Please input your birthday)
* Name of the Bank:
(Please input the bank name of your account.)
* Account user name:
(this was automatic use your apply name in COOPER BANK)
* Account Number:
(Please input your bank account number.)
*COOPER BANK account:
(Please input your COOPER BANK account number.)
Currency:
 (please input the currency you deposite.)
* Withdraw Amount
(Please input the money amount you withdraw)
* Country:
(Please choose your country)
* State:
 (Choose your state; Ex: England)
* City:
(Choose your city; Ex: London)
* Address:
(Choose your address; Ex: SUIE 8525, 16-18 CIRCUS ROAD ST. JOHN'S WOOD )
* Post Code:
(Choose your postcode; Ex: NW8 6PG)
* Home Number:
(Input your Home Landline number; Ex: +44-20-8123-2768)
* Mobile:
(Input your mobile phone number; Ex: +44-7791330999
Office Number:
(Input your office number; Ex:+44-20-8123-2769)
* Certificate Type:
(Choose your certificate type.)
* Certificate Number:
(Input your certificate number)
Validate Code:        Click here to reflash the validate code
 
 
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Copyright ©2006 cooper bank. All rights reserved.
COOPER BANK, SUIE 8525, 16-18 CIRCUS ROAD, ST. JOHN'S WOOD, LONDON,UNITED KINGDOM,NW8 6PG