Intermediary Bank (if applicable) Intermediary Bank Name (Forward through this bank, primary not online direct with FRB) Intermediary Bank ABA# Intermediary Bank Account#

Receiving Party's Information
Beneficiary of Account to credit (Name of Account holder)
Account Number to credit (Final credit to)		Individual      Company
Additional Information or Special Instructions

Member Information
First Name	Last	Member Number	SSN
E-mail address:

Wire funds from this account		Checking	Savings
Phone Number where you can be reached within 3 hours

I agree that my account will be debited for this service. I hereby authorize Parsons Federal Credit Union to transfer funds by wire as shown above. I understand that the account shown will be debited for the amount of the wire, plus any applicable fees. I agree to hold the Credit Union harmless if the funds are not received and credited due to incorrect or incomplete instructions or information. A $25.00 tracer fee (research request) will be deducted from my account in the event this wire is lost through no fault of Parsons Federal Credit Union.

X___________________________________________________________________________ Authorized Signature Please print and sign this form. Parsons Federal Credit Union must have this form hand delivered, mailed to Parsons Federal Credit Union, P. O. Box 90667, Pasadena, CA 91109-0667 or faxed to (626) 440-9405 within 14 days for your request to be processed. Please make sure to include the signed Wire Transfer Disclosure Form as well. (Wires are due by 2:30 pm in order to be sent the same day). back to website