Wilshire State Bank Wire Transfer Application And Instructions
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1
2WIRE TRANSFER APPLICATION AND INSTRUCTIONS
송 금 신 청 서
TYPE OR PRINT FIRMLY 꼭 눌러서 기입해 주십시요.
Date:
Wire Amt: $
Fee: $
Total
송금액
수수료
Received: $
Faxed Application: Yes (
)
Verification of Faxed Application:
Cash
Check
Method of Payment
Fax Agreement on File:
Customer Info:
Debit Acct
Others
Yes (
)
No (
)
Verified By:
Name:
Account No:
Customer
이름
구좌번호
(Remitter)
Address:
Telephone:
Information
주소
전화
고객/송금인
(Non Customer Only)
Identification :
신분증
Name:
Beneficiary
이름
Bank
Address:
Information
주소
지급은행
City:
Country:
ABA No:
도시
나라
Name:
Telephone:
Beneficiary
이름
전화
(Payee)
Information
Account No:
구좌번호
받으시는 분
Address:
주소
Name:
Intermediary
이름
Bank
Address:
Information
주소
City:
Country:
ABA No:
도시
나라
Special Instructions
특별지시사항
By signing below, you confirm that: (a) you have verified the information set forth above, and (b) you have read and agree to the
Wire Transfer Application and Instructions Terms set forth on the reverse side.
_____________________________________________________________
_______________________
Customer Signature
Date
BRANCH OR DEPARTMENT
FUNDS
OFAC
BRANCH NO
ACCEPTED BY
APPROVED BY
AVAILABILITY
CHECKED
CHECKED BY
WIRE DEPARTMENT
EXECUTION DATE
REFERENCE NUMBER
ENTERED BY
APPROVED BY
OPS-321 (REV. 07/2005)
WHITE - BANK
YELLOW - CUSTOMER
PINK - BRANCH
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