Wire Request For Mortgage Payoff Form printable pdf download

PEOPLES Community Credit Union

OUTGOING WIRE REQUEST FORM

Member Information:

(Originator)

Member Name:

Account #: ___

Suffix:

Address: ____________________________________________________________________________

Best Phone Number to reach you on date of Wire: ______________________________

Type of ID and ID#__________________________________________________________________

Wire Information:

Wire Amt: $

__ + Fee Amt: $ 30.00_ = Total: $

Intermediary Financial Institution Information

: ( IF APPLICABLE-Financial

Institution that the wire may pass through if required by the Beneficiary Financial

Institution)

ABA/Routing/SWIFT: ______________________________________________________________

Name of Financial Institution: ____________________________________________________

Address: ____________________________________________________________________________

City, State, Zip: ____________________________________________________________________

Beneficiary Financial Institution Information:

Further Credit to -

ABA/Routing Number _____________________________________________________________

Name of Financial Institution: _____________________________________________________

Address: _____________________________________________________________________________

City, State, Zip: _____________________________________________________________________

Beneficiary Information:

Final Credit to -

Account Number: ___________________________________________________________________

Name: _______________________________________________________________________________

Address: _____________________________________________________________________________

City, State, Zip: _____________________________________________________________________

Additional Payment Information: (if applicable) _______________________________

______________________________________________________________________________________

By signing this Wire Transfer Request, I (1) agree to all the terms and conditions of the PEOPLES

Community Credit Union Outgoing Wire Transfer Agreement, and (2) confirm that all of the information

above is correct.

Member Signature:

Date: ___/___/___

Request taken by: __________ __/__/__

Transaction performed by: __________ __/__/__

Wire input and initiated by: __________ __/__/__

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Wire Request For Mortgage Payoff Form