Authorization To Wire Bank Funds Form

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AUTHORIZATION TO WIRE BANK FUNDS
Use this form to wire funds from Scottrade Bank to another financial institution. A different form is required to wire funds from Scottrade Brokerage.
1. SCOTTRADE BANK ACCOUNT HOLDER INFORMATION
Bank Account Title (Name on Account)
Bank Account Number
Bank Account Type
Telephone Number
Social Security or Tax ID Number
E-mail Address
Reason for the Request (For your account protection, please be as specific as possible.)
2. RECEIVING FINANCIAL INSTITUTION INFORMATION
Telephone Number
Name of Receiving Financial Institution
Receiving Bank's Wire ABA/Routing Number
Bank Address
City, State and ZIP
3. AMOUNT OF WIRE TRANSFER
.
Dollar Amount Only
4. RECIPIENT BENEFICIARY INFORMATION
Recipient's Account Title at Receiving Institution (full title - "same"/"self" are not acceptable)
Account Number at Financial Institution
Recipient's Street Address (no P.O. boxes)
State
City
ZIP
Your Relationship to Recipient
5. FOR FURTHER CREDIT TO (If Applicable)
Account Title at Receiving Institution (full title - "same"/"self" are not acceptable)
Account Number
Recipient's Street Address (no P.O. boxes)
ZIP
City
State
Please note that if you are wiring to a third party or international recipient a valid, non-expired, government issued ID must be submitted with the request.
Outgoing wires: $25 fee for domestic wires. No international wires. Wire transfer requests are only accepted from established bank customers.
Scottrade Bank Wire Transfer Agreement and Disclaimer
1. I (we) the Account Holder(s) authorize Scottrade Bank("Bank") to make the wire transfer described on the attached form.
2. I (we) request the Bank to effect this transfer at my (our) risk to such person(s) as the receiving bank believes to be the within name payee. This may be based solely on the
ABA, SSN/Tax ID Number(s) and/or Account Number(s) that have been provided by me (us).
3. You agree to hold the Bank harmless from any loss that occurs if your instructions are incomplete, unclear or incorrect. The Bank is not required to seek clarification from
anyone regarding ambiguous instructions. If we cannot complete a transfer due to unclear or inaccurate instructions, we will attempt to notify you via phone or by e-mail by the
end of the next business day.
4. For security purposes, the Bank may require further verification of wire requests via phone or e-mail. Successful verification of these wires must be completed prior to
processing the request. Therefore, it is important that your contact information on this form is correct.
5. Scottrade Bank may transfer funds through an Intermediary Bank or funds transfer system that is different from that shown in your instructions.
6. If the Bank receives your payment order after our end of processing day cut-off, or on Saturday, Sunday or holiday, it may be processed on the next funds-transfer business day.
7. You may only cancel your order prior to the wire transfer being transmitted by the Bank. You agree to hold the Bank harmless from all claims and damages, however, if the
Bank attempts (successfully or otherwise) to comply with your cancellation or change request.
8. You agree to notify the Bank immediately if you notice any discrepancy involving the posting of your payment order or if you discover a problem with your transfer. You must
send us a written notice of the problem, including a statement of the relevant facts, within a reasonable time (not to exceed 10 days from the date you first discover the problem
or statement cycle, whichever occurs first).
9. Scottrade Bank will not be liable for consequential, special, punitive, or exemplary damages or losses of any kind. We will not be liable for any failure to act or delay due to: a
lack of sufficient available funds in your account; circumstances beyond our control; fire, flood, or natural disasters; communication failures; labor disputes; any inaccuracy in
your instructions; the action or inaction of others; or any applicable government or funds-transfer system rule, policy, or regulation.
Signature(s) of Account Holder(s): I acknowledge that I have read Scottrade Bank's Wire Transfer Agreement and Disclaimer
BRANCH USE ONLY
X
Customer request received and approved by:
Account Holder's Signature
Date
SCOTTRADE BANK USE ONLY
Received by:
Approved by:
*BA9303*
X
Input by:
Verified/Sent by:
OFAC by:
Joint Account Holder's Signature
Date
Submit this form to your local brokerage branch office.
BA9303/8-14

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