Domestic Wire-transfer Request

* Indicates Required

• ORIGINATOR INFORMATION

  First, Middle and Last Name or Business Name*

  Member Number*

  Account Type*

  Share (Savings) Draft (Checking)

  Account Type is required.

  Amount of Transfer*

  Physical Address (NO P.O. Boxes or Mailboxes)*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip Code*

  Email*

  
  

• RECEIVING FINANCIAL INSTITUTION INFORMATION

  Institution Name*

  ABA, Routing, or Transfer Number*

  Phone Number*

  Physical Address (NO P.O. Boxes or Mailboxes)*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip Code*

  Special Instructions (if none, leave blank)

  
  

• BENEFICIARY INFORMATION

  First, Middle and Last Name or Business Name*

  Account Number*

  Phone Number*

  Physical Address (NO P.O. Boxes or Mailboxes)*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip Code*

  Relationship to Account Owner*

  Special Instructions (if none, leave blank)

  
  

• ACKNOWLEDGEMENT

  • The undersigned represents that the above information is correct and acknowledges responsibility for any errors resulting from incorrect/inaccurate information provided. The undersigned authorizes Actors Federal Credit Union (“ActorsFCU”) to use any means it deems suitable for the transmission of the funds, understands, and agrees that in carrying out this payment order, ActorsFCU acts only as an agent. The undersigned hereby releases ActorsFCU from all liability from any loss unless the loss arises out of ActorsFCU's failure to exercise ordinary care, failure to act in good faith, or failure to act in accordance with the undersigned's instructions given pursuant to this authorization. If the undersigned's authorization identifies the beneficiary both by a name and an identifying number or bank account number and the name and number identify different persons, payment or cancellation of the payment order may be made solely on the basis of the number. ActorsFCU complies with all State and Federal laws that govern wire transfers. ActorsFCU will not be liable to make any refund to the undersigned for canceled requests until after ActorsFCU receives confirmation of the returned funds. The undersigned agrees to promptly review all notices from ActorsFCU regarding the execution of funds transfer for the undersigned.
    
    
  • The undersigned will advise ActorsFCU of erroneously executed funds transfers within two (2) business days following notification. The two (2) business day period shall begin to run after the undersigned has received sufficient information to reasonably determine that the funds transfer was erroneous. The undersigned understands and agrees, ActorsFCU has no influence or responsibility for fees or surcharges imposed by other financial institutions involved in the transfer of the funds. In addition, a delay in the payment order request may be caused by, but not limited to, insufficient information, insufficient funds, security procedures, verification, and/or conversion into a foreign currency, as applicable.
    
    
  • ActorsFCU has established reasonable security procedures, which may change from time to time. The undersigned will be notified of the security procedure, if any, to be used to verify payment orders issued by the undersigned or for which the account will be liable. The undersigned agrees that the authenticity of this payment order shall be verified using that security procedure, unless the undersigned notifies ActorsFCU, in writing, that the undersigned does not agree to that security procedure. In that event, ActorsFCU will have no obligation to accept any payment order from the undersigned or other authorized parties on the account until the undersigned and ActorsFCU agree, in writing, of an alternative security procedure. This Wire Transfer Agreement & Authorization applies only to the wire transfer identified above.
    
    
  • Wire transfer instructions received after deadlines [Domestic (4:30 p.m. Eastern / 3:30 p.m. Central / 1:30 p.m. Pacific) – International (3:30 p.m. Eastern / 2:30 p.m. Central / 12:30 p.m. Pacific)] on a business day, Saturdays, Sundays, Federal Reserve Bank holidays or a day ActorsFCU is closed for business, will be processed the following business day.

  
  
  

• Signature

  Member Signature*

  Clear Signature

  Date*

  Phone Number*

  Phone Type*

  Home Cell Work Other

  Phone Type is required.

  
  

  To verify your identity, please attach a valid ID below

  Accepted ID types include: government issued photo ID, i.e.: State issued driver's license, US passport, or equivalent.

  An Attachment is required.

  Select files from your computer
  or simply drag & drop them here

  Accepted formats: .pages, .doc, .docx, .pdf, .png, .jpg.