MEMBER: DATE:
STREET ADDRESS:
CITY, STATE, ZIP CODE:
ACCOUNT #: PURPOSE:
ACCOUNT # TO BE CHARGED: ACCOUNT TITLE: AVAILABLE BALANCE:
TRANSFER AMOUNT: PFCU FEES: TOTAL CHARGED TO ACCOUNT:
WIRE AMOUNT IN US$: PFCU FEES: TOTAL CHARGED TO ACCOUNT:
FI NAME: FI ABA NUMBER:
FI CITY & STATE: FI COUNTRY (if not USA):
FI NAME: FI ABA NUMBER:
FI CITY & STATE: FI COUNTRY (if not USA):
NAME: ACCOUNT #:
STREET ADDRESS:
CITY, STATE, ZIP CODE: COUNTRY (if not USA):
SPECIAL INSTRUCTIONS:
MEMBER SIGNATURE
DATE:
MEMBER SIGNATURE VERIFIED BY: HOLD PLACED HOLD PLACED BY:
APPROVING OFFICER: OFAC SENDER: OFAC RECEIVER:
TIME REQUEST RECEIVED:
WIRE ENTERED BY: WIRE VERIFIED BY: DATE & TIME VERIFIED:
INTERNATIONAL TRANSFER
INTERMEDIARY FINANCIAL INSTITUTION
You can Fax Wire Form to 678-399-2768 or Email: Wire@PlatinumFCU.org
Please make sure we have Valid Phone Number & Email Address on File for Verification Purposes
PLATINUM FEDERAL CREDIT UNION
BENEFICIARY
RECEIVING FINANCIAL INSTITUTION
REQUEST FOR FUNDS TRANSFER
DOMESTIC TRANSFER
$ 15.00
$ 15.00
$ 34.99
$ 34.99
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome