Request For A Domestic Wire Transfer: Please Note

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Navy Federal®
Request for a Domestic Wire Transfer For Office Use Only
Access No.
408838
Funds are generally received at the other financial institution within one to two business
Account No.
days. Additional fees may be assessed by the receiving financial institution.
702397847
Please note:
Navy Federal cannot guarantee cancellation once the wire has been processed. Navy Federal will submit a reversal request to the payee’s
financial institution and make every attempt to retrieve the funds; however, there is no guarantee that the funds will be returned. Once
received by the payee and/or payee’s financial institution, the reversal of the wire is at the discretion of the payee’s financial institution.
Navy Federal cannot guarantee the response time of the payee’s financial institution, and fees may be assessed by other financial institutions
if the reversal request is successful.

A. Member Information
Name: First MI Last Suffix
Charmin N. Jacobs
Best Contact Number Account Number* Date (MM/DD/YY)
☐ Business ☐ Cell ☐ Home 702397847 11/15/21

B. Payment Type Information


Transfer Amount Delivery Fee Requester Information
$ 1135.75 $14.00 ☐ Member ☐ Power of Attorney ☐ Other _________________________________________________________________

C. Financial Institution Information


Name of Payee’s Financial Institution
CITIBANK N.A

Address: City State


111 Wall Street, New York, NY 10043

Name of Primary Correspondent Bank ABA Number


Internet Escrow Services Inc 021000089

Intermediary Financial Institution ID Type (BIC) ID Number

Address City State/Province Postal Code

D. Payee’s Information
Name: First MI Last Suffix Is Payee a Third Party?
Internet Escrow Services Inc
☐ Yes ☐ No
Payee Address: Street City State Zip Code
180 Montgomery St., Suite 650, San Francisco, CA 94104

Country Purpose of Payment Payee Account Number


31044399
USA
Remarks (additional wiring instructions)
Reference Escrow Transaction #11537268

Requester’s Signature (if applicable) Date (MM/DD/YY)

*This is the account that the funds will be withdrawn from.

For Office Use Only


Employee Initials Employee Number Date (MM/DD/YY)

OPF No. Member ID

© 2020 Navy Federal NFCU 755A (12-20)

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