Texas Tech Western Union Wire Form
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1WESTERN UNION WIRE FORM
(DOMESTIC)
(1) Date
(2) Wire Amount
(USD $ and $2,500 or less)
(3) Member #
(4) Checking or Savings?
ORIGINATOR INFORMATION
(5) Originator First Name
(6) Originator Last Name
(7) Originator Address
(8) Originator City, ST ZIP
(9) Originator Phone #
RECIPIENT INFORMATION
(11) Recipient First & Middle
Name
(12) Recipient Last Name
(13) Recipient Address
(14) Recipient City, ST ZIP
(15) (Optional) For additional security, you have the option of providing a physical description of the recipient or a test question and test
answer that the recipient will have to provide, or both.
Physical Description _________________________________________
~or~
Test Question
___________________________________
Answer
___________________________________
(16) Payout Location - City
(17) Payout Location - State
(18) Recipient’s DL#
(required)
(19) Recipient’s Birthday
(not required if recipient is a TTFCU member)
NOTE: Please communicate to the recipient that he or she may need to alert their Western Union representative that the wire may
need to be located within their system as coming from Corporate America Credit Union.
Signature:
X______________________________________
Your D.O.B.:_____________________
Print
PLEASE BE ADVISED:
You will be charged a fee of $20 per Domestic Western Union wire and $35 per International Western Union wire. All fields on this form are
required. Wires with incomplete forms will not be sent. The daily cut-off for Western Union wires is 3:30 pm Central. If your request is
received after cut-off time, the wire will be sent on the next business day. Western Union wires typically take up to 1 hour to be available for
pickup. If the beneficiary has not received the wire in 12 hours, please contact us.
Texas Tech Federal Credit Union
Box 41072 Texas Tech University
Lubbock TX 79409-1072
Tel 806-742-3606
Fax 742-7033
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