Scribd
Upload
1K views1 page

Wire Transfer Form 09

This document is an outgoing wire transfer form that requests a wire payment be made from the originator's account to a recipient or beneficiary account. It notes a 3:00 PM EST cutoff time for wires and that wires cannot be processed for non-customers. The originator agrees the wire transfer is irrevocable and the bank is only responsible for ordinary care in processing. International wires may involve currency conversion unless the receiving account is designated as US dollars. Customer signature and verification is required to authorize the debit from their account.

Uploaded by

allisonllua
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
1K views1 page

Wire Transfer Form 09

This document is an outgoing wire transfer form that requests a wire payment be made from the originator's account to a recipient or beneficiary account. It notes a 3:00 PM EST cutoff time for wires and that wires cannot be processed for non-customers. The originator agrees the wire transfer is irrevocable and the bank is only responsible for ordinary care in processing. International wires may involve currency conversion unless the receiving account is designated as US dollars. Customer signature and verification is required to authorize the debit from their account.

Uploaded by

allisonllua
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
  • Outgoing Wire Transfer Form

Outgoing Wire Transfer Form

Please Note: Wire cut off time is 3:00 PM EST. Wires cannot be processed for non-customers.

The undersigned originator requests payment to be made to the recipient or account number named below. To the extent not
prohibited by law, the undersigned agrees that this wire transfer is irrevocable and that the sole obligation of the institution
named above is to exercise ordinary care in processing this wire transfer and that it is not responsible for any losses or delays
which may occur as a result of any other party’s involvement in processing this transfer. Notice to customers sending
International Wire Transfers: US Dollars may be converted to the foreign currency unless receiving account is
specifically designated as a US Dollar account.

Receiving Financial Institution Information


Receiving Financial Institution Name

ABA #: OR (Must be 9 digits and online with the Federal Reserve Bank)

Swift Code: (Must be included for all international wires)

HVSB Customer Information Beneficiary Information


Name and Address of Originator: Name and Address of Beneficiary:

Account # of Origination Account # of Beneficiary:

Further Credit To:


Amount of Wire-

Date of Wire
Special Instructions:
Wire fee: $25 – Domestic; $40 – International

I authorize Huron Valley State Bank to debit my account, referenced above, for the wire amount and fee indicated for this wire
transfer. Please note: For your security, we require a signature for all outgoing wire transfer requests.

_________________________________________ _________________________
Customer’s Signature Date
(Must be an authorized signor on the account that will be debited)

Branch/Dept Use Only: Accounting/Operations Use Only:

Wire form accepted by Input into Jack Henry by:


Input into UBB by:
Customer signature verified: _________________
Initiated by: Approved by:
Verified collected funds are available: __________
Possible OFAC Match: Yes No
Approve override if funds are not available: _________ True OFAC Match: Yes No
For Wire Request NOT initiated in person:

Call back performed by ___________________

You might also like