Access No.
Account No.
Transfer Amount
$
☐ ☐ ☐ _________________________________________________________________
Name of Payee’s Financial Institution
Address: City State
Name of Primary Correspondent Bank ABA Number
Intermediary Financial Institution ID Type (BIC) ID Number
Address City State/Province Postal Code
Name: First MI Last Suffix
☐ ☐ ☐
Account Number
*
Date (MM/DD/YY)
Employee Initials Employee Number Date (MM/DD/YY)
OPF No. Member ID
Name: First MI Last Suffix
☐ ☐
Payee Address: Street City State Zip Code
Country Purpose of Payment Payee Account Number
Remarks (additional wiring instructions)
Requester’s Signature (if applicable) Date (MM/DD/YY)
*This is the account that the funds will be withdrawn from.
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
Navy Federal
®
Request for a Domestic Wire Transfer
For Ofce Use Only
Funds are generally received at the other nancial institution within one to two business
days. Additional fees may be assessed by the receiving nancial institution.
Please note:
Navy Federal cannot guarantee cancellation once the wire has been processed. Navy Federal will submit a reversal request to the payee’s
nancial institution and make every attempt to retrieve the funds; however, there is no guarantee that the funds will be returned. Once
received by the payee and/or payee’s nancial institution, the reversal of the wire is at the discretion of the payee’s nancial institution.
Navy Federal cannot guarantee the response time of the payee’s nancial institution, and fees may be assessed by other nancial institutions
if the reversal request is successful.
A. Member Information
Best Contact Number
Business Cell Home
B. Payment Type Information
Delivery Fee
$14.00
Requester Information
Member Power of Attorney Other
C. Financial Institution Information
D. Payee’s Information
Is Payee a Third Party?
Yes No
For Ofce Use Only
© 2020 Navy Federal NFCU 755A (12-20)
