Polar Investment Counsel Inc.       

Member: FINRA, NFA, MSRB, SIPC

Independent Securities & Futures Brokers

Home Office: Thief River Falls MN

Annual Compliance Packages have been sent * Please complete all elements by April 1 2019 * U4 Review - Compliance Certificationn - Compliance Meeting - OBA Review - NFA Attestation

 

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FUND DISBURSEMENT

 

All disbursements and requests are processed by the Home Office.  Please do not send anything directly to Hilltop Securities.  This form is to be used to process the following:  On Demand IRA Distributions, Check Requests, ACH Requests and Fed Wire Requests.  One time IRA distributions are to be sent directly to the Home Office via email and require a separate form.  ACH requests must have prior set-up (allow 3 days) with the proper forms.  ALL wire requests must have the Fed Wire Authorization form signed by the client - no exceptions

 

Cut-Off Times

Fed Wire :  1:00 pm Central Time (must allow 30 min process time prior to cut-off)

Check Requests :  2:00 pm Central Time.  Checks are only sent to client's address of record.

NCFA Requests:  Do  not use this form - must be submitted separately via email (see below)

 

COMPLETE ALL APPLICABLE AREAS BELOW TO ENTER YOUR REQUEST


Client Information and Amount of Disbursement

 

Date:     Account Number:      

 

Office Number:         Rep  ID:  

 

Account Name:    

 

Amount Requested:  

 

Written Amount Requested: Dollars

 


 

  IRA ON DEMAND DISTRIBUTION (current form on file)

  Check       ACH       Internal Journal to account:

RMD Year

 

An account cannot be closed with an on demand distribution.  To close the account, submit a separate distribution form via email to the Home Office.

 


 

  CHECK REQUESTS   (non qualified accounts only)                         Close Account  

 

Checks can only be made out to the exact name on the account (account title) and can only be mailed to the address of record.  Please advise client that the check comes in a one part-envelope separation type document and can be mistaken for junk mail.

    


 

  ACH REQUEST  (must have prior set-up of ACH instructions)    Close Account 

  Outgoing Request        Internal Transfer Request to account

  Incoming Request   Amount of Incoming ACH:

 


 

 FEDERAL WIRE REQUEST  - Recipient Bank Information   

Charge Wire Fee to Rep#:          Charge Wire Fee to Client 

         

Bank Name:           

ABA Number:     City-State:       

Country  (Foreign Wires Only):  

For Further Credit to Account Number:  

 

Account Title at Bank:  

Customer Account Number:      

US Citizen:   Yes    No

Final Beneficiary Name (if applicable):  

 


Broker Acknowledgment:

 

By entering my name below, this constitutes my signature and consent to submitting the above fund disbursement request on behalf of client.  The  information submitted will be sent via email to the Home Office who will process the request.

 

Rep Name:     Date:  

 

          

 


Note:  On occasion, the Firm may request additional information or a client's written signature and/or notarization if the amount of the request is questionable.  Should such a situation arise, you will be informed via email or phone. 

 

Note:  Any fund requests for non-clearing firm accounts should be requested via email to

Sherry Abbott - sabbott@polarinvest1.com as additional forms may be required.  Please include:  client name, entity funds are to come from, amount and reason

 

Note:  Third party wires are generally not allowed.  Please contact the Home Office for further instructions.  Foreign Third Party wires are never allowed.

 

 

 

 

PICI 2019

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Polar Investment Counsel Inc.

19547 210th Ave NE   Thief River Falls MN  56701  

218-681-7344 ~ 218-681-1329 {fax}

     Mike  Jordan - President, CEO          Sherry Abbott - Exec VP, CCO, CFO

mjordan@polarinvest1.com                sabbott@polarinvest1.com