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70 Westview Street Lexington, MA 02421 T 617-253-2845

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70 Westview Street
Lexington, MA 02421
T 617-253-2845 | F 781-205-2250
operations@mitfcu.mit.edu
www.mitfcu.org
DOMESTIC WIRE TRANSFER
AUTHORIZATION REQUEST
Member Name:
Address:
Phone Number:
I request MIT Federal Credit Union to withdraw
$
from my account number
suffix
. I request the funds to be sent via Wire Transfer to the following financial institution:
Name of Receiving Financial Institution
Routing and Transit Number
Beneficiary
Account Number
For Further Credit To / Special Instruction
Account Number
Originator’s Financial Institution
Routing Number
MIT Federal Credit Union
211381754
Regulation J is the law governing all wire transfer transactions. If you provide MIT Federal Credit Union a payment order which
identifies the beneficiary (recipient of funds) by both name and account number, payment may be made by the beneficiary’s
bank on the basis of the account number, even if the number identifies a person different than the named beneficiary. If you
provide MIT Federal Credit Union a payment order which identifies an intermediary or beneficiary’s bank by both name and
account number, the receiving bank may rely on the number as the proper identification even if it identifies a different person
than the named bank.
If you are submitting this Wire Transfer authorization request via fax or email, you will be contacted by an MIT FCU
representative before the wire will be processed. MIT Federal Credit Union can only call you at the phone number
that is currently on file.
We do not accept electronic or digital signatures.
Member Signature Date
V09.09.21 Page 1 of 1
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70 Westview Street Lexington, MA 02421 T 617-253-2845

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Completed 5 May 2022

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