Fillable Western Union Request printable pdf download

WESTERN UNION REQUEST

Requests received after 4:00 pm will be processed the next business day.

NOTE: If you are unsure how to fill out this form, please call Community Financial Credit Union at (888) 430.7199. Returning incorrect,

incomplete or unsigned forms will delay the processing of your request. We may call back any member who requests a Western Union.

Verification must be completed prior to processing Western Union. If we are unable to make verifications by 4:00 p.m., the wire will be

processed the following business day.

Date Requested:

Time Requested:

Request Made:

In person ID #_____________

Fax

Mail

General Information

___

Western Union Amount $

Member Account Number

Member Name

Address

City:

State

Zip Code:

Phone Numbers: Work

Home

Other

Beneficiary Information

Name:

Address:

City:

State

Zip Code:

Deliver Funds to: City:

State:

REQUIRED: Special Identifier of Recipient (ie: SSN, TIN):

Advise member that their receiving party should ask specifically for a “Will call money transfer from Missouri Corporate

Credit Union, St. Louis, MO.” Receiving party will also need to supply Western Union with a ten digit Tracking Number

which will be provided by Community Financial Credit Union.

By signing this form, I agree that I have read the ACH & WIRE TRANSFERS AGREEMENT located in the Membership and Account

Agreement and agree that the information entered on this form is accurate, including the account numbers and financial institution

information. I cannot hold Community Financial Credit Union liable for any incorrect information provided by me. I authorize

Community Financial Credit Union to process a wire transfer per the wiring instructions I have given above. I understand that my

account will be charged a fee. I understand that this wire transfer request may be delayed until security procedures are completed.

NOTICE: By Federal Law, all Wire Funds Transfers are verified against the Office of Foreign Asset Control’s (OFAC) Specifically

Designated Nationals (SDN) List.

Member Signature _________________________________________________

Date: ___________________

FOR OFFICE USE ONLY:

Signature Verified by:

Wire Sequence No.:

Verified By:

Time:

OFAC Passed(Employee Initials):

Wire Processed by:

OFAC Passed MOCORP

(Employee Initials):

Security Verification

(Call Back – if applicable) by:

10 digit Tracking Number

__________________________________

Member called:

_______

(Employee Initials):

815 W. Tampa • Springfield, MO 65802 • 1220 E. Walnut Lawn • Springfield, MO 65804

417.862.0471 • 888.430.7199 • FAX: 417.862.7802 •

Western Union Request

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