Today’s Date Financial Institution Receiving Funds Primary Destination Bank Name (Final Destination) Primary Destination Bank ABA# Dollar Amt $ Forwarding Bank Information – For Admin. Use Only – Secondary Bank Name (Forward through this bank, primary not online direct with FRB) Secondary Bank ABA# Receiving Party’s Information Name FirstLast Address Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP Code Account Number to credit (Final credit to) Individual Company Beneficiary of Account to credit (Name of Account holder) Further credit to (name) Additional Information or Special Instructions Member Information Name FirstLast Member Number SSN Address Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP Code E-mail address: Mother’s Maiden Name Wire funds from this account Phone Number where you can be reached within 3 hours I agree that my account will be debited for this service. I hereby authorize Omaha Federal Credit Union to transfer funds by wire as shown above. I understand that the account shown will be debited for the amount of the wire, plus any applicable fees. I agree to hold the Credit Union harmless if the funds are not received and credited due to incorrect or incomplete instructions or information. Wires are due by 4pm in order to be sent the same day. Comments This field is for validation purposes and should be left unchanged.