Common Contracts
1 similar International Wire Transfer Agreement contracts
PLEASE READ THE AGREEMENT ON PAGE 2 INCLUDING YOUR 30‐MINUTE RESCISSION PERIOD RIGHTSInternational Wire Transfer Agreement • February 12th, 2014
Wire Request Originator Information Social Security #: Transfer From: (Member Account # with Suffix) Date Wire Transfer Requested: Member Name: (First, MI, Last) Email Address: Street Mailing Address: City: State: Zip: Primary Phone Number: Secondary Phone Number: Fax Number: Member Signature: Date: Wire Transfer Information: Amount: Currency Type: (i.e.: USD, GBP…) Wire Fee: (Please refer to disclosure) Bank Information: Receiving Institution Swift/BIC Code: IBAN #: Beneficiary Institution: (if applicable) Swift/BIC Code: (if applicable) Beneficiary Institution Account #: (if applicable) Receiving Institution City/Region & Country: Branch Code/Routing No.: (if known) Other Bank Information: Final Credit Recipient: Name: (First, MI, Last or Company) Account No.: Address: Region: Post Code: Country: Other Information:
