KFCUL24112-10/19
Authorization for Wire Transfer
1440 Rosecrans Avenue, Manhattan Beach, CA 90266
800.854.9846 | kinecta.org
EPS
Wire Dept Processor (Sig / Initials) Wire Dept Approver (Sig / Initials) Amount Verified OFAC Verified
Wire Transfer requests may be processed at any local Kinecta Member Service Center.
Wire CUT OFF times: requests must be received no later than 12:30 PM PST for Domestic Wires and 11:30 AM PST for International Wires.
SECTION 1
Wire Date Wire Amount
Wire Type (Check One)
International Wire Disclosure Provided
Name (Member / Joint / Authorized Signer) Credit Union Account Number Share ID to Debit
Address City / State / Zip Daytime Phone
SECTION 2
Destination Financial Institution Information
Financial Institution Name
Routing (ABA) Number (Domestic) Swiftcode (International)
Financial Institution Street Address City / State / Zip Country
Purpose Of Payment
SECTION 3
Beneficiary (Recipient) Information
Beneficiary Name (As it appears on the account) Beneficiary Account Number
Street Address City / State / Zip Country
Special Instructions
SECTION 4
Intermediary Financial Institution Information
Financial Institution Name
Routing (ABA) Number (Domestic) Swiftcode (International)
Financial Institution Street Address City / State / Zip Country
AUTHORIZATION
General Wire Information
By signing below, I agree to the terms herein and certify the information on this form is complete and correct. I authorize Kinecta Federal Credit Union to transfer funds as shown on this wire request form.
I am responsible for the accuracy of the above information. Notwithstanding knowledge of any inconsistency, the Credit Union and subsequent parties to the wire transfer order may act solely on the basis
of the account number if the name and number disagree. The Credit Union will send the funds by any funds transfer payment system or intermediary financial institution at its discretion. Confirmation of
receipt from the recipient is not required; if requested, the Credit Union will request confirmation but will not be responsible for receipt. A confirmation request fee may be assessed. I understand that
there is a fee associated with sending a wire and that the funds will be withdrawn from my account when the wire is sent (see Schedule of Fees and Charges). In addition, the Credit Union will have no
obligation to pay interest on any cancelled, returned, or rejected wire transfer order. The Credit Union is not responsible to any transferee, beneficiary, or other party as a result of this wire transfer order
nor shall the Credit Union be liable for insolvency, neglect, misconduct, mistake, or default of another institution or person, including an originator, except as provided in this request form. The Credit
Union will be liable only to its immediate originator only for failure to credit the amount of this wire transfer order to the recipient account solely as a result of the Credit Union’s failure to exercise ordinary
care or act in good faith. The Credit Union’s liability for such failure will be limited to the amount of the transfer order plus lost interest or as otherwise required by law. Subject to the foregoing, the Credit
Union’s responsibility for loss of interest for error or delay shall be calculated using a rate equal to the average Fed Funds rate of the Federal Reserve Bank of San Francisco for the period involved. The
terms and provisions provided on the next page entitled “Important Imformation” are incorporated herein by reference.
Domestic Wire Only
There is no right to cancel or amend the transfer order. The Credit Union, at its option, may attempt cancellation or amendment if this application has been acted on, but will have no liability if the
cancellation or amendment is not effectuated. If the wire transfer request is cancelled, the Credit Union will not credit funds until the Credit Union confirms the recipient has not received the funds, and any
funds transmitted have been returned. The Credit Union has no obligation to re-execute any rejected or returned transfer order. The Credit Union will credit any account following return or rejection. Any
credit may not be equal to original amount due to wire fees, and expenses of the Credit Union or other institutions.
International Wire Only
If the transfer order request is for payment in a foreign country the Credit Union may execute the wire transfer order in such foreign country’s currency at the Credit Union’s buying rate of exchange for
U.S. dollars when the transfer is affected. For international funds transfers, you have the right to cancel your funds transfer via written or verbal request within 30 minutes of paying for the transfer if:
(1) Your request to cancel enables the Credit Union to identify your name and address or telephone number and the particular transfer to be canceled; and
(2) The transferred funds have not been picked up by the designated recipient or deposited into an account of the designated recipient.
The Credit Union shall refund, at no additional cost to you, the total amount of funds provided by you in connection with the funds transfer, including any fees and, to the extent not prohibited by law,
taxes imposed in connection with the transfer, within three business days of receiving your request to cancel the transfer order.
Signature (Member / Joint Owner / Authorized Signer) Today’s Date
SECTION 5
Department Department Contact # Member Identification Date / Time Accepted
Accepted By (Print Name) Accepted By (Signature) Approved By (Print Name) Approved By (Signature)
Approved By (Print Name) Approved By (Signature) Approved By (Print Name) Approved By (Signature)
q Domestic q International
q In-Person
q Fax
q Email
