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Outgoing Wire Transfer Form

The document provides information about wire transfers from KS StateBank. It details domestic and international wire transfer requirements and deadlines. It also includes sections for client and beneficiary information as well as an agreement the client must sign.

Uploaded by

Ferdee Ferd
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
169 views

Outgoing Wire Transfer Form

The document provides information about wire transfers from KS StateBank. It details domestic and international wire transfer requirements and deadlines. It also includes sections for client and beneficiary information as well as an agreement the client must sign.

Uploaded by

Ferdee Ferd
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Revised 01-01-2015

Outgoing Wire Transfer


ABOUT WIRE TRANSFERS
KS StateBank only completes wire transfers for its clients. To be processed the same day, domestic transfer requests must be received by 3 p.m.
(CST) and international transfer requests must be received by 2 p.m. (CST). These deadlines may be earlier on Federal holidays. Requests
received after that time will be processed effective the next business day.

CLIENT (REQUESTOR) INFORMATION

Wire Date Client Name

Phone Number Requestor

Account Number Address

City State Zip

Wire Amount (Funds are transferred in $ U.S. unless otherwise directed.) Fee

DOMESTIC WIRE TRANSFER – BENEFICIARY BANK INFORMATION

Routing Number Bank Name

City State Zip

INTERNATIONAL WIRE TRANSFER – BENEFICIARY BANK INFORMATION

Swift Code Bank Name

Address (Required)

BENEFICIARY (RECIPIENT) INFORMATION

Name

Account Number Address (Required on International wire transfers.)

City State Zip

Additional Information

AGREEMENT
I represent I have the authority to make this wire transfer request on behalf of the account holder and from the account entered above. I authorize KS StateBank (“Bank”) to honor this
request to wire transfer funds from such account, and the Bank may rely in good faith on the information I have entered on this form. I acknowledge the Bank may take such actions it
deems appropriate to verify this request, and may at its sole discretion decline to accept this request and perform the wire transfer. I acknowledge and agree the Bank shall not be liable for
any loss or expense arising from the Bank’s actions regarding this request, and the Bank’s records shall be binding on all parties. I agree to pay the fees charged to such account in
accordance with Bank’s fee schedule.

Signature or Wire PIN Date

FOR OFFICE USE ONLY


Available Funds OFAC Check PIN Verification Call Back
TO SUBMIT
This request may be presented at any KS
StateBank office or mailed to KS StateBank,
Received By Date Time Received Date
Wire Transfer Department,
1010 Westloop Place, Manhattan, KS 66502.
Sent By Date Verified By Date

KS StateBank | 1010 Westloop Place | Manhattan, KS 66502

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