<p> Valwood Park FCU</p><p>Member Wire Transfer Agreement</p><p>Member Information:</p><p>1. Member’s Name: ______</p><p>Social Security NO.: Driver’s License No.:______</p><p>2. Member Account Number No.: ______</p><p> Please choose the type of account to debit: ___ Savings (or) ____ Checking </p><p>3. Member Account Address: (Street) ______</p><p>(City) ______(State) ______(ZIP) ______</p><p>4. Telephone Number member can be reached at: ______</p><p>5. Dollar amount to be sent: $ ______</p><p>RECEIVING BANKS WIRING INSTRUCTIONS:</p><p>ABA Routing Number: ( 9-digits )</p><p>Bank Name: ______</p><p>Branch Address: ______</p><p>City/State/Zip Code: ______</p><p>Bank Telephone: Number:______</p><p>Final Credit lnformation Special instructions (Name on Escrow Account & Number, etc.)</p><p>6. Name on Account at Recent Bank: ______</p><p>7. Address of person Receiving Funds: (Street) ______</p><p>(City)______(State) ______(ZIP) ______</p><p>. Account Number at Receiving Bank: ______</p><p>9. Type of Account at Receiving Bank (i.e. savings, checking) ______</p><p>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.</p><p>Member’s Signature: Date: ______</p><p>VERIFICATION METHOD: Date & Time Processed: ______</p><p>___ Driver’s License No. ___ Signature ___ Person Known ___ Mother’s Maiden Name</p><p>Call Back: Member’s Phone NO. (If amount is over $2,500) ______Time______</p><p>Supervisor/Manager Sig: ______Staff: ______</p>