Clear Form

Account Closure or Partial Withdrawal Request(Checking/Savings/Time Deposit)
Instructions
1. Complete all fields, as applicable. Notarization is required.
2. Wire instructions are required for receiving funds internationally or for receiving funds of $1,000,000 or greater.
3. Ensure that you have the appropriate signatures/notary and any supporting documentation as indicated below.
4. Return to one of the addresses in the below table.
Overnight Courier

Regular Mail

Wells Fargo Bank, N.A.
Exception Payments Account Closures
MAC N9160-01X
1801 Park View Dr 1st FlShoreview, MN 55126-5030

Wells Fargo Bank, N.A.
Exception Payments Account Closures
MAC N9160-01X
P.O. Box 9102
Minneapolis, MN 55480-9102

Please note:• Only an authorized signer may close the account.
• Funds will only be remitted in the name as it reads on the current Wells Fargo account statement the funds are being withdrawn from.
• For parties outside the U.S., you must provide complete wiring instructions in order to receive your funds.
Important Reminders:• Prepare your account for closure before submitting your request:o Accounts must have a zero or positive balance in order to be closed.
o All deposits, outstanding and pending items must be posted to the account in order to be closed.
o Any recurring payments or withdrawals from your account need to be cancelled before your request to close (examples include bill payments
and debit card payments) otherwise, they may be returned unpaid.
• Certain conditions on your account may prevent closure:o Legal or bank restrictions need to be resolved.
o Funds pledged for collateral or other purposes need to be released.
o For assistance or questions please call Wells Fargo Phone BankSM at 1-800-TO-WELLS (1-800-869-3557). For business accounts,Wells Fargo’s National Business Banking Center at 1-800-CALL WELLS (1-800-225-5935).

Section 1. Customer Information
Customer Name (First, M.I., Last)
Current Customer Address (Street #/Name)
City

Apt.#
State

ZIP CodeCountry

Contact Information
Phone Number (Required)Best Days/Times to Contact You

Email Address-- TRS Telephone Relay Assistance Required

595396 (Rev 11 – 11/22)-- Language Interpreter Required

Preferred Language ___________________________________

Page 1 of 4

Section 2. Account Information
Please provide the following information for each account:
Account #Account TypeBranch where account opened (optional)

Business
Account

Checking
Account

Savings
Account

Certificate of
Deposit AccountBusiness
Account

Checking
Account

Savings
Account

Certificate of
Deposit AccountBusiness
Account

Checking
Account

Savings
Account

Certificate of
Deposit AccountBusiness
Account

Checking
Account

Savings
Account

Certificate of
Deposit AccountBusiness
Account

Checking
Account

Savings
Account

Certificate of
Deposit AccountBusiness Accounts•

If the account(s) is (are) business account(s) and you are not an authorized signer, you must submit the appropriate businessdocumentation to evidence signing authority (for example: corporate resolution, certified board meeting minutes, operating
agreement, Amended Articles of Incorporation and Articles of Dissolution) along with this form. Upon closure of the account the check
will be made payable to the business name on the account.

Time Deposit Accounts
Initial next to the appropriate selection.
If the account(s) is (are) time deposit account(s): I acknowledge that I may be subject to an early withdrawal penalty or a Regulation D
penalty in connection with a partial withdrawal or closing my time deposit prior to maturity. Please refer to the applicable Fee & Information
Schedule and Account Agreement for further information.

I choose to close account(s) at maturity. Requests can be submitted up to 30 days prior to the maturity date.

Section 3. Account Closure/Partial Withdrawal Instructions
Type of Account Closure/Partial Withdrawal (select one):
Partial withdrawal (specify amount) $Close account and transfer to my Wells Fargo (checking/savings) account #Close account and send funds as instructed below:
Receipt of Funds (select one):
Cashier’s Check (within the U.S. only)
Deliver via U.S. Mail – no charge
Deliver via overnight courier - courier fees deducted from check proceeds
Deliver via overnight courier signature required – courier fees deducted from check proceeds Deliver to current
customer address (Section 1)
Deliver to address below: (if different from current customer address in Section 1)
Note: No third party transactions are permitted.
Name
Address (Street #/Name)
City595396 (Rev 11 – 11/22)

Apt.#StateZIP CodeCountryPage 2 of 4

Wire Transfer (Domestic or International)

Note: A fee may apply for each domestic or international wire transfer, depending on your account type. Please refer to your Consumer Account Fee andInformation Schedule or your Business Account Fee and Information Schedule. Applicable fees will be deducted from the account balance.

Please provide the account and routing information below: (All wires are sent in U.S. Dollars only)
Exact Customer Name (as it appears on the account at the receiving institution) No third party transactions are permitted.
Name of Institution
Intermediary Bank Name (if applicable)
Account Number/International Bank Account Number [Examples: IBAN, CLABE (Required for transfers to Mexico), CPAPRN, IFSC, etc.]
Routing Transit Number (for U.S. Banks)

SWIFT BIC (for International Wires)

Sort CodeSection 4. Reason for Closing
Please check one box:
Personal CircumstancesMoving (77)

Deceased (81)Other Circumstances
No longer needs account (85)Life Events (86)Lost/Stolen Account or Card (87)Business no longer exists (88)

Identity Theft (95)

Other (99)595396 (Rev 11 – 11/22)

Page 3 of 4

Section 5. Signature and Notary
Wells Fargo requires that you have this document notarized to protect your identity and ensure fastest processing of your request. If
you are having this document notarized internationally, please refer to the U.S. Embassy/U.S. Consulate for notarization or a legal
confirmation of your signature (known as an Apostille Guarantee) from a government agency in your country.
Notary: You may attach your own acknowledgement form if the language below does not meet your State requirement.

STATE OF_______________________

COUNTY OF _______________________

Subscribed and sworn to before me on theday of, 20, the undersigned,a Notary Public in and for said State, personally appeared(Name of Customer)
proved to me on the basis of satisfactory evidence/to be the person(s) whose name(s) is/are subscribed to the within instrument
and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/theirsignature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State ofthat theforgoing paragraph is true and correct.

XCustomer Signature

WITNESS my hand and official seal

Notary Public Signature

Notary Public Name (Typed or Printed)

My Commission Expires

Notary SealChecklist••••

Have you provided contact information in case we need to reach you?
Have you provided account numbers?
If receiving funds by wire transfer, did you provide the required bank and account information?
If this is a business account, and you are not indicated as an authorized signer on the account, have you provided the corporate
resolution or certified board meeting minutes?

For questions and assistance, call 866-990-0814.

© 2022 Wells Fargo Bank, N.A. All rights reserved.
595396 (Rev 11 – 11/22)

Page 4 of 4