AUTHORIZATION FOR WIRE TRANSFER
I hereby authorize the Clara Barton Federal Credit Union to withdraw
the following amount and send to the designated
financial institution per my wire instructions. I understand that there is a fee of $15.00
for domestic wire transfer
and $50.00 for an international wire transfer, and that the funds will be withdrawn
from my account when the
wire is sent. (Please print all instructions.)
Member's Name and Address _____________________________________________________
Telephone ____________________________________________________________________
Signature _____________________________________ Account Number __________________
Check one: _____ Domestic Wire _____ International Wire
............................................................................................................................................................................
OUTGOING WIRE INSTRUCTIONS
Wire Transfer Amount $_______________________ Wire Date ___________________________
Destination Bank _______________________________________________________________
ABA# __ __ __ __ __ __ __ __ __ Sort Code
______________ Swift Code __________________
(Domestic Only) (International Only)
Branch office & Address __________________________________________________________
______________________________________________________________________________
To: Account name _______________________________________________________________
Address (required _________________________________________________________________To: Account Number ____________________ Int'l Bank Phone#____________________________
Special Instructions:
______________________________________________________________
______________________________________________________________________________
(Wire instructions from other institutions should be attached to this form if available.)
WE CANNOT ACCEPT RESPONSIBILITY FOR DELAYS IN WIRE TRANSMISSIONS BECAUSE OF INACCURATE OR INCOMPLETE WIRE INSTRUCTIONS. PLEASE ALLOW TWO TO FOUR BUSINESS DAYS FOR INTERNATIONAL WIRES TO REACH DESTINATION BANK.
Please print this form, fill out all
necessary information and mail it to us at 2025 E St. NW, LL1,
Washington, DC, 20006 or fax it to us at 202-303-0136.
................................................................................................................................................................................
Credit Union Use Only
Funds verified by: _____________________________
Processed by: ________________________
VCFCU called: Time __________ Date __________ By ___________________________________