OUTGOING WIRE TRANSFER INSTRUCTIONS & AUTHORIZATION [PDF]

OUTGOING WIRE TRANSFER INSTRUCTIONS & AUTHORIZATION WIRE AMOUNT Fee Total

$______________ ______________ ______________

WIRE TO: (Receiving Financial Institution Information) ABA # ___________________________________ FOR INTERNATIONAL WIRE ONLY: SWIFT CODE ________________________

BENEFICIARY: (Receiver Information) Account #_______________________________ Name & Address: _______________________________________ Street__________________________________ Mailing_________________________________ City, State, Zip___________________________ (Credit Union Verified ______________________________ )

FI Name__________________________________ Street ____________________________________ City, State, Zip_____________________________

PURPOSE OF PAYMENT _______________ _______________________________________

(Credit Union Verified _____________________________ )

BANK TO BANK INFO: (If Any) ________________________________________ ________________________________________ ________________________________________

ORIGINATOR: (Member Name & Current Address) _________________________________________ Street____________________________________ Mailing __________________________________ City, State, Zip ____________________________ MEMBER # _____________________________ METHOD OF PAYMENT: [ ] DEDUCT ACCT #_________________ [ ] CASH [ ] CHECK

ORIGINATOR TO BENEFICIARY INFO: (If Any) ________________________________________ ________________________________________ ________________________________________

I understand that wire transfers initiated through the Federal Reserve are governed by The Uniform Commercial Code, Article 4A and regulation “J”, and that I may request an additional copy of the disclosure which outlines my responsibilities in the wire process I desire. I understand it is my responsibility to fully complete the above form and to provide accurate account and routing numbers to the Credit Union. Failure to do so will delay the wire. I have reviewed the above numbers and they are accurate. The Credit Union and other institutions may rely on these numbers even if they identify a different party or institution. I understand the cutoff deadlines and I authorize Garden Island FCU to wire the funds from my account and to deduct the fee. I acknowledge that some receiving banks and intermediary banks may also charge a fee for their services which will be deducted from the proceeds of the wire. I also understand that the Credit Union does not guarantee the time this wire will be available at the receiving institution and that some international wires may be delayed. I will not hold the Credit Union responsible in any way for the delays or losses incurred by me because of any daily exchange rate fluctuations. This form must be signed in ink by the authorized member/owner and submitted with the original signature to the credit union.

______________________________________________ Member/Owner Signature

_____/_____/_____ Date

********************************************************************************************** Received By (CU Staff) __________________________ Date _____/_____/_____ Time ________ AM/PM Wire initiated via Catalyst Corp FCU by _____________

Date

_____/_____/_____ Time ________ AM/PM

Verified By ___________________ (Revised 2/2017)

2973 Kele Street * P O Box 1165 * Lihue, Hawaii 96766-5165 Administration (808) 245-2712 * Loan Department (808) 245-2192 * Fax (808) 245-7241