International Wire Transfer Request

* Required Fields

Account Number: *

Account Type: *

Amount of Wire: * (International Wire Fee: $50)

Reason for Transfer: *

Email: *

First Name: *

Middle Initial:

Last Name: *

Maiden Name (if applicable):

Street Address: *

City: *

State: *

Zip: *

Home Phone: *

Work Phone:

Cell Phone:

It is requested that funds be wire transferred from the above account to the following financial institution:

Financial Institution: *

Financial Institution Address: *

Address Line 2:

City: *

State/Province/Region: *

Zip/Postal Code: *

Swift Code: *

IBAN Number:

Intermediary Bank (if applicable):

Intermediary Bank:

Intermediary Bank Address:

Address Line 2:

City:

State/Province/Region:

Zip/Postal Code:

Country:

Funds to be Credited to:

Beneficiary Name: *

Beneficiary Address: *

Beneficiary Address 2:

City: *

State/Province/Region: *

Zip/Postal Code: *

Country: *

Account Number: *

Account Type: *

Additional Remarks:

The undersigned authorizes EPFCU to initiate the transfer of funds and charge the account as indicated. EPFCU is released from all responsibility, obligation and/or costs associated with other bank's actions, fees, or failure to deliver funds. I hereby accept and understand that any fees, charges or communication levied by correspondent banks with respect to this transaction are the responsibility of either the Remitter, the Beneficiary, or both.

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International Wire Transfer Request

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