Member Wire Transfer Agreement

Valwood Park FCU

Member Information:

1. Member’s Name: ______

Social Security NO.: Driver’s License No.:______

2. Member Account Number No.: ______

 Please choose the type of account to debit: ___ Savings (or) ____ Checking

3. Member Account Address: (Street) ______

(City) ______(State) ______(ZIP) ______

4. Telephone Number member can be reached at: ______

5. Dollar amount to be sent: $ ______

RECEIVING BANKS WIRING INSTRUCTIONS:

ABA Routing Number: ( 9-digits )

Bank Name: ______

Branch Address: ______

City/State/Zip Code: ______

Bank Telephone: Number:______

Final Credit lnformation Special instructions (Name on Escrow Account & Number, etc.)

6. Name on Account at Recent Bank: ______

7. Address of person Receiving Funds: (Street) ______

(City)______(State) ______(ZIP) ______

. Account Number at Receiving Bank: ______

9. Type of Account at Receiving Bank (i.e. savings, checking) ______

I hereby authori ze Valwo od Park Federal Credit Union to transf er f unds by wire according to instructions giv en to the credit union on this form or by f ax or phon e. I und ersta nd that my accou nt shown will be debite d for the amoun t of the wire and any applicabl e f ees. I agree to hold Valwo od Park Federal Credit Union harmless if the f unds are not receiv ed and credited due to incorrect inf ormation. I hav e read the Valwoo d Park Federal Credit Union funds transf er auth orizatio n agreemen t.

Member’s Signature: Date: ______

VERIFICATION METHOD: Date & Time Processed: ______

___ Driver’s License No. ___ Signature ___ Person Known ___ Mother’s Maiden Name

Call Back: Member’s Phone NO. (If amount is over $2,500) ______Time______

Supervisor/Manager Sig: ______Staff: ______