Fillable Debit from Inspirus Account Number (Inspirus Credit Union)

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Debit from Inspirus Account Number (Inspirus Credit Union)

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Country of origin: US
File type: PDF

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A DIVISION OF Gesa CREDIT UNION
Outgoing Wire Request
To transfer funds domestically or internationally without delay, please
ensure this form is filled out completely and accurately. Please note:
addresses of all parties are required for 1) domestic wires of $3,000 or
more and 2) all international wires, regardless of the amount.
Member Information
Member Number
Member Name (first and last)
Address (PO Box cannot be used)
City, ST, and ZIP
Phone Number for Wire Verification Callback
(including area code)
E-mail Address
Wire Information
Wire Amount
$
Debit from Inspirus Account Number
Purpose of Wire
Wire to
Bank Name
Routing Number/SWIFT/BIC
Address line 1
Address line 2
City, State (Province), ZIP (Postal Code)
Country (if not USA)
Other information/reference
Credit to
Account number/IBAN
Account type
Name
Address line 1
Address line 2
Address line 3
Other information/reference
Final Credit to (beneficiary)
Account number/IBAN
Account type
Name
Address line 1
Address line 2
Address line 3
Other information/reference
Signature
Signature and callback phone number are required for FAX & In-person requests
FAX # 206-676-1008
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Debit from Inspirus Account Number (Inspirus Credit Union)

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Completed 5 March 2021

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