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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