Norhtwest Federal Credit Union

Foreign Wire Transfer

All fields with * are required.
FAX completed forms to 703-709-9510.

Originator - Member Information

Member's Name:*

Account Number:*

Account Type:

ID:
Address:*

Telephone Number:*

Email Address*:

 

This will be used to provide your receipt of the wire transaction

Personal Fax Number:*

 

This will be used to provide your receipt of the wire transaction

Please choose selection that applies:

Transfer $

FEE: $50 = Total Debit $ **

(US Dollars)

Transfer $ worth of

FEE: $50 = Total Debit $ **

(US Dollars)                                 (Foreign Currency)

Transfer $  FEE: $50 = Total Debit $ **

(Foreign Currency)

**Amount received by recipient may be reduced by other transfer fees. Receipt will be provided.
Receiving Bank and Individual Recipient Information

Foreign Institution Name:*

City, Country:*

Recipient Name:*

Recipient Address:*

Swift Code:*

Recipient Account Number:*

Additional information is needed for wires sent to the following countries:

European Union:  IBAN:

Korea:  Contact Name and Phone #:

Taiwan:  Contact Name and Phone #:

India:  Financial System Code (11 alpha numeric):

Canada:  Transit Code (9 numbers):

Special Instructions:

To be completed by Credit Union:

Reference Number:

Time Sent:

By clicking here I am submitting this international remittance transfer request for a foreign wire electronically in compliance with ESIGN and I authorize Northwest Federal Credit Union (NWFCU) to process the request using the information I have provided. I agree to the $50 fee assessed by NWFCU and understand that the recipient of the funds may receive less than the transfer amount indicated on the form above due to fees charged by intermediary financial institutions including the recipient's bank and foreign fees and taxes. I authorize NWFCU to email or send via facsimile the pre-disclosure and receipt to the email or facsimile (fax) number listed above and understand that if I do not contact NWFCU at 703-709-8901 and ask for ACH/Wire Department or call directly at 703-709-8900 x4851 or 800-336-3384 x4851 within 30 minutes of the receipt being sent to my email or facsimile, the remittance transfer will be sent and I will be unable to cancel or modify the instructions and transfer amount indicated above. I understand that in the event I provided an incorrect account number or recipient institution identifier, I can lose the transfer amount.

Member Signature:* Date:*

Click here to print form. After clicking submit, please sign and fax completed form to NWFCU at 703-709-9510.