International 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*

  Wire Type*

  Consumer to Consumer Consumer to Business Business to Business Business to Consumer

  Wire Type is required.

  Send in Type*

  US Dollars to US Dollars Fixed US Dollars to Foreign Currency US Dollars to Fixed Foreign Currency

  Send in Type is required.

  Foreign Currency Type*

  Purpose of Wire*

  Include details such as nature of transaction, use of proceeds, relationship to recipients(s), etc.

  
  

• RECEIVING FINANCIAL INSTITUTION INFORMATION

  Institution Name*

  
  

  At least 2 of the following pieces of information are needed from the receiving financial institution*

  SWIFT Code*

  SWIFT Code

  BIC Code*

  BIC Code

  IBAN Number*

  IBAN Number

  ABA Routing Number*

  ABA Routing Number

  National ID*

  National ID

  Please select at least 2 options

  
  

  Country *

  UNITED STATES CANADA AUSTRALIA AUSTRIA BELGIUM CHINA FRANCE GERMANY HONG KONG INDIA INDONESIA IRELAND ISRAEL ITALY JAPAN MEXICO NETHERLANDS NEW ZEALAND PAKISTAN PHILLIPINES POLAND RUSSIA SINGAPORE SOUTH KOREA SPAIN SWAZILAND SWITZERLAND TAIWAN UNITED KINGDOM UNITED STATES OF AMERICA Other

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

  Apartment/Suite/etc. (if applicable)

  District/Sub-locality*

  District/Sub-locality (if applicable)

  City/Locality *

  State *

  AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware DC - District of Columbia FL - Florida GA - Georgia GU - Guam HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MH - Marshall Islands MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PW - Palau PA - Pennsylvania PR - Puerto Rico RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VT - Vermont VI - Virgin Islands VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming

  Zip Code *

  County

  Prefecture *

  Region *

  Province *

  Oblast/Republic/etc. *

  Province/State/Etc. (if applicable)

  Postal Code*

  State *

  Postal Code *

  Country *

  Special Instructions (if none, leave blank)

  
  

• BENEFICIARY INFORMATION

  First, Middle and Last Name or Business Name*

  Account Number*

  Phone Number*

  Country *

  UNITED STATES CANADA AUSTRALIA AUSTRIA BELGIUM CHINA FRANCE GERMANY HONG KONG INDIA INDONESIA IRELAND ISRAEL ITALY JAPAN MEXICO NETHERLANDS NEW ZEALAND PAKISTAN PHILLIPINES POLAND RUSSIA SINGAPORE SOUTH KOREA SPAIN SWAZILAND SWITZERLAND TAIWAN UNITED KINGDOM UNITED STATES OF AMERICA Other

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

  Apartment/Suite/etc. (if applicable)

  District/Sub-locality*

  District/Sub-locality (if applicable)

  City/Locality *

  State *

  AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware DC - District of Columbia FL - Florida GA - Georgia GU - Guam HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MH - Marshall Islands MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PW - Palau PA - Pennsylvania PR - Puerto Rico RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VT - Vermont VI - Virgin Islands VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming

  Zip Code *

  County

  Prefecture *

  Region *

  Province *

  Oblast/Republic/etc. *

  Province/State/Etc. (if applicable)

  Postal Code*

  State *

  Postal Code *

  Country *

  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.
    
    
  • International transfers are sent in the currency selected above, if no selection is made, the transfer will be sent in the receiving country's common currency. Member must approve exchange rate by replying to the pre-receipt email sent by the credit union within ten (10) minutes. If approval is received after a new rate will apply and the member will receive a new pre-receipt for approval. If the member does not reply to the pre-receipt email within 30 minutes the wire transfer request will be cancelled. A new request must be submitted to re-attempt wire transfer. Once we have received the acceptance of exchange rate and the wire has been sent, the member will receive a final receipt and will have no more than 30 (thirty) minutes to cancel transfer request.
    
    
  • 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.