Follow these steps
1. Minimum foreign draft amount is $100.00 USD.
2. Complete this form online, print and sign this form.
3. Bring this form and a picture ID to any American Savings Bank (“ASB”) branch.
Part A - Tell us about yourself
Part B - If on behalf of an ASB Business Customer, complete Part B, otherwise skip to Part C
Part C - Payment information
Part E - Type and amount of currency
Part F - AUTHORIZATION and SIGNATURE
PRINT LEGIBLY:
Name:___________________________________________________________________________________________________________________________________________________________________________________
Address:________________________________________________________________________________________________________________________________________________________________________________
City:______________________________________________________________________ State/Country:_______________________________________ Zip Code + 4:_______________________________
Birthdate (For individuals only):___________________________________ Social Security Number/Tax ID:____________________________________________________________________
Identification Type:___________________________________________________ Identification Number:____________________________ Issued By:____________________________________
Name of American Savings Bank Business Customer:_____________________________________________________________________________________________________________________
Part D - Payee information
Name of Payee:_______________________________________________________________________________________________________________________________________________________________________
I authorize American Savings Bank to pay for the foreign draft FROM
Checking Savings Money Market
Account #
_________________________________________________________
Type of Currency:__________________________________________________________________________________________ Amount:______________________________________________________________
For Euro Draft, select the country where the draft will be mailed to:
Austria Finland Germany Ireland/Republic Luxembourg Portugal
Belgium France Greece Italy Netherlands Spain
Savings Bank
Foreign Draft Order
I (we) authorize American Savings Bank to issue the foreign draft through Bank of America. I authorize that the account above be debited. I am
an owner or an authorized signer on the account to be debited, and confirm that the payee information above is correct. I agree that if the
foreign draft order is submitted to any American Savings Bank branch during business hours by 10:00 AM HST, the draft will be ready for pick
up at the branch within three (3) business days, and if submitted after that time, the draft will be ready for pick up within four (4) business days.
Signature______________________________________________________________________________________ Date________________________________ Cell Phone_______________________________
Email Address:_______________________________________________________________________________ Work Phone______________________ Home Phone____________________________
NOTE: The person requesting the foreign draft must be an
account owner or authorized to transact on the account (if a
Business), on the FROM account. If payment from a savings
account, withdrawal limits apply.
** FOR BANK USE ONLY **
Date:
Branch Name/Number:
FX Rate Code:
Accepted By:
Foreign Draft Amount:
Rate:
(Use Wire Draft Rate Sheet)
USD Equivalent: Fee: Total:
[NOTE: If $3,000 - $10,000 in cash, complete Monetary Instrument Log; if more than $10,000 in cash, complete Currency Transaction Report]
Special Instructions:
INTL-003 (Rev 11/2015) 15K349 Member FDIC
