Wire Transfer Request/Authorization Form

Wire Type: *

International Wire Type (Select ONE) *
The undersigned represents that the above information is correct and acknowledges responsibility for any errors resulting from incorrect/ inaccurate information provided. The undersigned authorizes Maple Federal Credit Union (the “Credit Union”) to use any means it deems suitable for the transmission of the funds and understands and agrees that in carrying out this wire transfer, the Credit Union acts only as an agent. The undersigned hereby releases the Credit Union from all liability from any loss unless the loss arises out of the Credit Union’s failure to exercise ordinary care, failure to act in good faith, or failure to act in accordance with the undersigned’s instructions given pursuant to this Authorization. If the undersigned’s Authorization identifies the beneficiary both by a name and an identifying or bank account number and the name and number identify different persons, payment or cancellation of the order may be made solely on the basis of the number. The Fedwire System may be used for this wire transfer. Federal Reserve Regulation J is the law covering Fedwire transactions. The Credit Union will not be liable to make any refund to the undersigned for canceled requests until after the Credit Union receives confirmation of the returned funds. The Credit Union has no influence or responsibility for fees or surcharges imposed by other financial institutions involved in the transfer of the funds. Wire transfer instructions received after 3:00 p.m. Central Time may not be processed until the next business day, or if wire transfer instructions or received on a day the Federal Reserve Bank observes as a holiday and the Credit Union is open for business it will be processed on the following business day.
Maple Federal Credit Union charges a fee of $20.00 for domestic wires or $35.00 for international wires.
Member Signature *
Telephone Numbers
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