Wire Out Transfer Form


Please complete this form in its entirety to successfully request a wire transfer. Read ALL instructions. For best results, contact the receiving institution and verify their routing number. In addition, ask if there is “Further Credit Instructions” needed. All information provided in section one (1) must agree with the account information on file at MED5 FCU. If it does not match or you have made account address/phone changes in the last 30 days MED5 FCU is not allowed by law to wire funds. You cannot use a PO Box number for an address, you must use a physical verifiable address. A fee of $25 for domestic wires and $50 for international wires will be charged.

(1) SECTION ONE- SENDING MEMBERS INFORMATION
Name *
Name
Address *
Address
(2) SECTION TWO- RECEIVING FINANCIAL INSTITUTION INFORMATION
Address 1 *
Address 1
(3) SECTION THREE- FURTHER CREDIT INSTRUCTIONS
(4) SECTION FOUR- BENEFICIARY INFORMATION
Name *
Name
Address *
Address