Outgoing Domestic Wire Authorization Form

3400 Sumner Blvd. Raleigh, NC 27616
Phone: 800-849-5600 | Fax: 919-876-8018

Beneficiary (Recipient) Financial Institution

Amount:
Bank Name:
ABA/Routing #:

Member Information/Originator

I would like the funds to be taken out of:	Savings-S1 Checking-S75 Money Market-S20
Please process the $12 wire fee from:	Savings-S1 Checking-S75 Money Market-S20
Full Name:
Account:
Phone Number:
Physical Address:
City:	State:
Zip:
Purpose:

Name and Address of Account Holder at Receiving Institution

Full Name:
Account:
Physical Address:
City:	State:
Zip:
Special Instructions:

Intermediary Financial Institution (if applicable)

Name:
ABA/Routing #:
Address:
City:	State:
Zip:

Agreement To Terms & Conditions

You may identify the payee or any financial institution by name and by account number or other appropriate identifier. The Credit Union (and other institutions) may rely on the account or other identifying number as the proper identification, even if it identifies a different party or institution. You authorize the Credit Union to transfer funds as described herein and debit your account in the amount transferred, plus applicable charges. Fund/wire transfer may be governed under Regulation E or the Uniform Commercial Code (UCC), Article 4A, dependent upon the nature of the transaction. If a wire transfer is cleared through the Federal Reserve, the transaction will also be governed by Regulation J. I understand that if this request is received by ElecTel after the cut-off time, the wire request will be processed on the following business day. The ElecTel cut-off time is 2:00 PM Eastern Time. Requests made after 2:00 PM will be transmitted the next business day.

Member Electronic Signature:	Date: