Wire Transfer Instructions
Important Information: This document supports consumer domestic transfers, business domestic transfers, and business international transfers. This document will also support consumer international transfers that are not deemed remittance transfers.
Please select one: One time or Subject to Fund or Wire Transfer Agreement.
Please provide the following information for the sender or payer.
Name:______________________________________________________
Address:____________________________________________________
City, State, Zip:_______________________________________________
Day Phone Number:___________________________________________
Transfer Amount:$_____________________________________________
Special Payment Instructions from Sender:__________________________
____________________________________________________________
Please provide the following information for the recipient or payee.
Name:_______________________________________________________
Address:_____________________________________________________
City, State, Zip:________________________________________________
Country:_____________________________________________________
Special identifier of recipient:_____________________________________
Social Security Number or:______________________________________
Tax Identification Number or:_____________________________________
Driver’s License Number:________________________________________
Please provide the recipient or payee financial institution information.
Name of Financial Institution:_____________________________________
Address:_____________________________________________________
City, State, Zip:________________________________________________
A B A Routing or Transit Number:__________________________________
Swift or Sort Code:______________________________________________
Branch Information:_____________________________________________
Special Routing Instructions:______________________________________
_____________________________________________________________
Please provide the Intermediary Financial Institution Information.
Name of Financial Institution:______________________________________
Address:______________________________________________________
City, State, Zip:_________________________________________________
A B A Routing or Transit Number:__________________________________
Swift or Sort Code:______________________________________________
Branch Information:_____________________________________________
Special Routing Instructions:______________________________________
_____________________________________________________________
Currency Type Information:_______________________________________
Please provide your Member Number:_______________________________
Please provide the signature of the account owner or authorized person:
Signature:_____________________________________________________
Date signed:___________________________________________________
You may identify the payee or any financial institution by name, and by account number, or other appropriate identifier. The Credit Union (and other institutions) may rely on the account or other identifying number as the proper identification, even if it identifies a different party or institution. You authorize the Credit Union to transfer funds as described herein, and debit your account in the amount transferred, plus applicable charges. Fund or wire transfers may be governed under Regulation E or the Uniform Commercial Code (UCC), Article 4A, dependent upon the nature of the transaction. If a wire transfer is cleared through the Federal Reserve, the transaction will also be governed by Regulation J.
For questions and assistance, please contact us at 308-234-9311 or toll free at 888-838-5328.
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