International Wire Transfer Form

Please complete the form, print, sign and fax this form to CSULA FCU by 1:00 p.m.(PT) to have your funds wired the same business day. Wire requests received after 1:00 p.m.(PT) will be processed the following business day. If you have any questions, please call (323) 505-2600, weekdays between the hours of 8 a.m. and 4:00 p.m.

Fax to: (323) 505-2615

Fees: .See Schedule of Fees charges

Your Information (ORIGINATOR)	* Required Fields

* Member Name: (Originator/Sender)
* Member Street Address:
* City, State, Zip Code:
* Work Phone and Ext:
Home Phone:
Cell Phone:
Email:
* AMOUNT OF TRANSFER:
* DATE:
* Member Account Number: (to be Debited)
*From:	Checking or Savings
Recipient Bank Information

Transfer to * NAME OF RECEIVING BANK:
Receiving Bank's Swift or Bank #: (Contact your financial institution for the correct number)
Street Address of Receiving Bank:
City:
State, Zip Code:
Country:
Credit To * NAME OF BENEFICIARY: (Recipient)
* ACCOUNT NUMBER OF BENEFICIARY:
Street Address of Beneficiary: (Required)
City:
State, Zip Code:
Country:

SPECIAL PAYMENT INSTRUCTIONS OR REFERENCES:
(OR OTHER IDENTIFIERS OF THE BENEFICIARY)

Click here for the Wire Transfer Agreement

I am submitting a signed copy of the wire transfer agreement

Member Signature:

X__________________________________ Date:_____________

For Office Use Only
Employee Sending Wire:	Member ID Verified by:
( ) OFAC Validation ______	( ) Phone ( ) Sig. Card ( ) CDL
Date of Last File Maintenance:	( ) Password ( ) Passport
( ) Funds verified and transferred	Notes:

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