OUTGOING WIRE TRANSFER REQUEST

Domestic wire requests received after 4:00 pm CST and International wire requests received after 2:00 pm CST will be processed the next business day.

Call Back Verification required form wires over $10,000.00.
Domestic Wire Fee: $20.00
International Wire Fee: $45.00

* indicates a required field

1. Sender/Originator Information

*Account Number & Suffix
*Amount of Wire
*Name
*System Phone Number	Phone numbers not on file require phone ID verification.
*Address
*City
*State
*Zip
Cell Phone Number
*Fax/Email For WireXchange notifications

2. Beneficiary Information (This is the ultimate recipient of the wire transfer funds)

*Beneficiary Name
Beneficiary Phone Number
*Beneficiary Account Number (For International Wires this could be the IBAN #)
*Beneficiary Address (no PO Boxes)
*Beneficiary City
*Beneficiary State
*Beneficiary Zip
Additional Information for the Beneficiary (invoice number, purchase order, other notes)

3. Beneficiary Bank Information

*Beneficiary Bank Routing/ABA # (for International Wires this is a SWIFT/BIC code)
*Beneficiary Bank Name
*Beneficiary Bank Address (no PO boxes)
*Beneficiary Bank City
*Beneficiary Bank State
*Beneficiary Bank Zip
Beneficiary Bank Country (required for International wires)
Bank Account Number at Intermediary Bank (if applicable)
Additional Information

4. Intermediary Bank Information (This is the financial institution that the wire must pass through before reaching the final beneficiary bank.) This section is optional & may not be required for all wires. Routing of wire may be altered based on the most current relationship information available.

Intermediary Bank Routing/ABA # (for international wires this Is a SWIFT/BIC Code)
Intermediary Bank Name
Intermediary Bank Address (no PO Boxes)
Intermediary Bank City
Intermediary Bank State
Intermediary Bank Zip
Intermediary Bank Country (required for International Wires)
Additional Information