Common Contracts
2 similar And Agreement contracts
and Agreement FormAnd Agreement • August 5th, 2020
Please print legibly and complete ALL SECTIONS (front and back) of this application. Mail, fax, or email application by secure means only:
and Agreement FormAnd Agreement • August 11th, 2017
INSURED (REQUESTOR) INFORMATION Name of Insured: Date of Birth: / / (MM/ DD/YYYY) Insured ID Number: Street Address (No P.O. Box): City: State/Province: Postal Code: Country: Telephone Number/Email: Wire sent on behalf of (if applicable): WIRE TRANSFER CURRENCY SELECTIONS Check destination: International (outside U.S.)1 Domestic (inside U.S.) For international wires, funds will be sent in the currency of the destination country, where available. If you wish for the funds to be sent in U.S. dollars (Funds will be converted by local bank, unless recipient has a U.S. dollar account), please indicate by checking this box: Currency type if international (name of country and unit): BENEFICIARY (“RECIPIENT”) INFORMATION Name: Telephone Number/Email: Address shown on your bank account (no P.O. Box): City: State/Province: Postal Code: Country: SWIFT Code(Required for international payments): International Bank Account Number (IBAN)(Required if sending Euros): BENEFICIARY BANK (“RECIPIENT BANK”)
