Princeton University FCU Outgoing Wire Transfer

Date:_____________________________

Receiving Institution:________________________________________________

ABA Number/SWIFT CODE:_______________ Amount:_________________________

Member Name:______________________ Member Account Number:_______________

Address: __________________________________ Phone: __(      )_______________

1st Credit Union Institution(Optional)________________________________________________________

ABA Number: _____________________________

Address: __________________________________ Phone:__(     )________________

Further Credit Institution: _________________________________________________

ABA Number:________________________________

Address: ________________________________________________________________________

Final Credit: _____________________________ Account Number: _______________

Address:____________________________________ Phone:__(    )___________________

REQUEST MADE      _____ In Person ______Fax ______Letter

I understand there will be a charge of $__________ to my account for this wire service. Please note that there may be additional charges from the receiving institutions for the wired funds. It has also been explained to me that if the information I submitted on this form is incorrect in any way, I will be charged for any additional costs which may occur. I am also aware that settlement of wire transactions is done by account number, not name and I have verified that the above account number to receive the funds is correct.

Signature:_____________________________ Date:____________________________
For PUFCU Only

Employee:_________________ Can:______________ Date: ___________________

Verification: _________________________________ Date: ___________________