Consumer International Wire Transfer Combined Disclosure and Receipt
JP Morgan Chase Bank, N.A
Branch Name
Address and number
City, state
Today’s Date: Date funds Available to Recipient:
Wire Transfer Date: Chase Wire Tracking Number:
Sender:
Name of that guy
Recipient:
Persons name who is receiving
00002546214418458
Name again and type of account
Recipient Bank:
Name of bank
Address
City and state
Swift Code for that bank
Exchange Rate: $1 USD = 1 USD
Amount Sent and Charges: Amount to be Received by the Recipient:
Transfer Amount: $ .00 Transfer Amount: $ .00 MXN
Transfer Fees: + .00 Other Fees* -0.00 MXN
Transfer Taxes: +$0.00
Total: $ .00 Total to Recipient: 0,000.00
*charged by other institutions
The recipient may receive less due to fees charged by the recipient’s bank and foreign taxes.
If you provided us an incorrect account number for the recipient or an incorrect routing or identification
number for the recipient’s bank you could lose the amount of the transfer.
You have a right to dispute errors in your transaction. If you think there is an error, contact us within 180 days at
1-888-434-3030 or send an account inquiry via Secure Message Center on chase.com. You can also contact us
for a written explanation of your rights.
You can cancel this wire transfer at no cost within 30 minutes after you have authorized us to send this wire
transfer. Please contact 1-800-935-9935 or visit a Chase branch.
If you have question or complaints about JPMorgan Chase Bank, N. A. contact:
Consumer Financial Protection Bureau
1-855-411-2372
1-855-729-2373 (TTY/TDD)
www.consumerfinance.gov
JPMorgan Chase Bank, N.A. Member FDIC