International Outgoing Wire Transfer Request Form

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International Outgoing Wire Transfer Request Form
Date:________________________
SENDER INFORMATION
One-time Wire
Repeating Wire
Repeating Wire Password: _______________________________
Wire Amount: $ ________________USD
Meriwest Account Number to be debited: ______________________
Type of Account:
Consumer
Business
Name/Title of Account: _______________________________________________________________________
(Official name on the Account, e.g., Individual/Joint account Name, or Name of Trust, Business/Entity Name, etc.)
Name of Sender: ___________________________________ Sender’s Contact Number: ___________________
Sender’s Address: ___________________________________________________________________________
Street Address
City
State
Zip Code
Important Note: It is the policy of Meriwest Credit Union to prohibit the processing of a wire transfer request if, within the last thirty (30) days,
you have changed your address or contact information of record with Meriwest.
BENEFICIARY INFORMATION
Name of Beneficiary (Individual or Company): _____________________________________________________
Beneficiary Address: _________________________________________________________________________
Street Address
__________________________________________________________________________________________
City
State/Province
Country
Postal Code
BENEFICIARY BANK INFORMATION
Beneficiary Bank Country: _____________________________________________________________________
Beneficiary Account Number/ IBAN/CLABE:
__________________________________________________________________________________________
Beneficiary Bank Name: ______________________________________________________________________
Branch Name/Number: _______________________________________________________________________
Beneficiary Bank Address: _____________________________________________________________________
Street Address
__________________________________________________________________________________________
City
State/Province
Country
Postal Code
SWIFT Code/ BIC (Bank Identifier Code): _________________________________________________________
Any other routing information provided by Beneficiary Bank (Sort Code, IFSC Code, Foreign Routing No., etc.):
__________________________________________________________________________________________
Meriwest Credit Union Revised 08/08/17
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