Domestic Wire Transfer Request Form
(*) Required field  
Please Wire $ *
Amount (in words): *
Requested Date of Transfer: *
From XFCU Account #: *  Acct Description: 
WIRE TO:
Name of Bank: *
Address: *
City / State / Zip: * ,
Phone Number:
Routing Number:  (nine digit #)
WITH FURTHER CREDIT TO:
Name:
Account #:
Reference (optional):
WITH FINAL CREDIT TO:
Name: *
Account #: *
Address:
City / State / Zip: ,
Reference (optional):
Authorized by (print): *_____________________________________
Member Signature: _____________________________________
Driver's License #: * _____________________________________   Exp. Date: _______________
Day Phone: _____________________________________

I authorize Xceed Financial Federal Credit Union to transfer funds as shown on this wire request form. I am responsible for the accuracy of the above information. The Credit Union and subsequent parties to the wire transfer order may act solely on the basis of the account number if the name and number disagree, not withstanding knowledge of any inconsistency.

The Credit Union will send the funds by any funds transfer payment system or intermediary bank at its discretion. If the transfer order request is for payment in a foreign country the credit union may execute the wire transfer order in such foreign country’s currency at the Credit Union’s buying rate of exchange for U.S. dollars when the transfer is affected.

I understand that there is a fee associated with sending a wire (see Services and Fee Schedule) and I agree to promptly pay all charges imposed by the Credit Union in accordance with this request. The funds may be withdrawn from any of my accounts at the Credit Union when the wire is sent.

The Credit Union’s cut off time for sending wires out the same day is 12:00 p.m. PST. Sufficient available funds must be in my Credit Union account for at least 5 business days. The Credit Union reserves the right to employ verification methods (e.g., telephonic call-back) prior to processing any wire transfer request in order to ensure its authenticity. Credit to my account is still dependent on the receiving institutions after they have received the funds.

There is no right to cancel or amend the transfer order. The Credit Union, at its option, may attempt cancellation or amendment if this application has been acted on, but will have no liability if the cancellation or amendment is not effectuated. In any event, the Credit Union will not credit funds until the Credit Union confirms the recipient has not received funds, and any funds transmitted have been returned. The Credit Union has no obligation to re-execute any rejected or returned transfer order. The Credit Union will credit any account following return or rejection. Any credit may not be equal to original amount due to, for example, differences in foreign currency exchange rates, wire fees, and expenses of the Credit Union or other institutions. In addition, the Credit Union will have no obligation to pay dividends on any cancelled, returned, or rejected wire transfer order.

I understand that the processing of my wire transfer request may be delayed or rejected, without liability to the Credit Union, for circumstances beyond the Credit Union’s reasonable control or if the requested transfer: (1) is incomplete; (2) may exceed the collected, verified, and available funds on deposit in the designated account; (3) is either not authenticated to the Credit Union’s sole satisfaction or the Credit Union believes such request may not have been authorized by me; (4) would cause the Credit Union to violate a law, regulation or a government guideline or program; or (5) is not in accordance with any other requirement stated in this Agreement or is objectionable to the Credit Union for any other reason in the Credit Union’s sole discretion.

The Credit Union’s obligation is limited to engaging in the wire transfer transaction as instructed by me pursuant to this request. In performing its obligations hereunder, the Credit Union will be liable only to me if I have suffered a loss caused solely and directly by the Credit Union’s gross negligence or willful misconduct. Such liability will be limited to the amount of the transfer order plus lost dividends or as otherwise required by law. The Credit Union is not responsible to any transferee, beneficiary, or other party as a result of this wire transfer request nor shall the Credit Union be liable for insolvency, neglect, misconduct, mistake, or default of another institution or person Under no circumstances will the Credit Union be liable for any consequential, incidental, exemplary, special or indirect damages, losses, attorney’s fees, costs and expenses which may be suffered, sustained or incurred by reason of this wire transfer order.

I hereby agree to indemnify and hold the Credit Union harmless from and against any loss, claim, damage, liability, attorney’s fees, costs and expenses arising out of or resulting from, directly or indirectly, in whole or in part, any action taken by the Credit Union in reliance upon this request.

Sufficient available funds must be in your XFCU account for at least 5 business days and unverifiable deposits, incomplete information, etc. may delay the processing of your wire transfer. The deadline for guaranteeing the wire to be sent out the same day is 12:00pm PST. Credit to your account is still dependent on the receiving institutions after they have received the funds.

Wires will not be processed until we contact you after receiving your faxed/mailed form.

PLEASE RETURN SIGNED COPY AS SOON AS POSSIBLE TO:
XCEED FINANCIAL CREDIT UNION ,
888 North Nash Street
El Segundo, CA 90245-9975,
Attn: Contact Center
or fax the completed form to 310.640.0727
INTERNAL USE ONLY
OFAC Cleared Yes/No:_________________________________________________
Date:____________________________________   Time:______________________
Account Balance Verification Yes/No:____________________________________
Date Balance Became Available:________________________________________
Wire Transfer Preparer's Name: ________________________________________
Wire Transfer Preparer's Signature: _____________________________________
Date: _____________________________________
Wire Transfer Approver's Name: ________________________________________
Wire Transfer Approver's Signature: _____________________________________
Date: _____________________________________
Revision: 3/3/2010