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Corporate America Credit Union - Download as PDF

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					                                       Corporate America Family Credit Union
                                          Western Union Request Form

MEMBER INFORMATION


  Member #              __________________________                  From Account ___________________

  Member Name           ___________________________________________________________________________

  Member Address ___________________________________________________________________________

  Member Phone #            (______) _______ - _____________                       (______) _______ - _____________

  Member email________________________________________________

  Social Security Number ____________________________                                    Funds Verified by:
                                                                                         Fee amount:          Approved by:
  Amount to Be Sent         $___________________
                            All funds are sent in US Dollars




DESTINATION -       □    DOMESTIC             □      INTERNATIONAL

  Destination City ______________________________________________________

  State _________________________________________________________________________________

  Identification Available ______________________________



BENEFICIARY(Recipient) INFORMATION -                      □ SELF □ LEGAL OWNER □ THIRD PARTY
  Beneficiary’s (Recipient’s) Name _______________________________________________________________

  Address ____________________________________________________________________________________

  Phone (_____) ________ - ________________                         (_____) ________ - ________________



I, hereby authorize Corporate America Family Credit Union to transfer funds by Western Union as shown above. I understand that my
account will be debited for the amount of the funds transfer plus applicable fees. I agree to hold Corporate America Family Credit
Union harmless if the funds are not received and credited due to incorrect information provided above.

Member’s Signature _____________________________________ Date _________________ Time_______________




STAFF Use: Teller # ___________________         Recv’d: In Person   Phone   Fax   Mail
           What identification was verified____________________________________ Date__________ Time_________
_________________________________________________________________________________________________________________________
Operations Department Use
Verification Method________________ OFAC Verified________________ Verified by________________ Approved by________________
Input by________________ Date _______ Time________ (MTCN)Control #__________________________ Contact Added ___/___/_____


July 2008

				
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Description: Corporate America Credit Union document sample