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Get Heart Of Louisiana Credit Union Wire Transfer Request/authorization Form 2019-2024

N MEMBER INFORMATION: Member Name (Originator/ Sender) Member Account Number (to be debited) Member Street Address City, State, Zip Code INTERMEDIARY CORRESPONDENT BANK: (if necessary) Name of Intermediary Bank Intermediary Bank s Routing/ Transit Number Street Address of Intermediary Bank City, State, Zip Code SWIFT Code Special Payment Instructions or References (or other Identifiers of the Beneficiary) BENEFICIARY S BANK INFORMATION: Name of Receiving Bank Receiving Bank s Ro.

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