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Wire Transfer Authorization <br />*F!RsTAR <br />Customer Information <br />Name: <br />Address: <br />City: State: ZIP: <br />Amended Date: <br />Affiliate Code: <br />Account Number: <br />Account Number: <br />Account Number: <br />Hire Initiation Authorized Representatives <br />Please indicate who needs authorization and check the applicable function. <br />1. <br />2. <br />3. <br />4. <br />Name <br />Maximum Transfer Amount* <br />si`'t 4/ „e• <br />Telephone Number 14 <br />❑ ❑ 0 <br />❑ ❑ 0 <br />❑ ❑ 0 <br />❑ ❑ 0 <br />*Default is $0.00. <br />Please provide your fax number if you require notification for incoming wire transfer activity. <br />Fax# <br />Do you require daily mail confirmation on all wire transfer activity? yes 0 no 0 <br />Nonrepetitive Wire: All information is required to initiate a wire transfer. You would need to provide the <br />originator's name, address and account number; beneficiary bank, beneficiary name, <br />address, and account number; dollar amount and the value date of the wire transfer. <br />Semirepetitive Wire: You would need to provide the dollar amount, the value date, and the message to be <br />included with the wire. All other data is retained by the Wire Transfer system,. <br />Fully Repetitive Wire: You would need to provide the dollar amount and the value date. All other data is retained <br />by the Wire Transfer system. <br />Changes/Notices <br />The individual(s) listed below are authorized to issue wire transfer instructions pertaining to our <br />account(s) at Firstar Bank in accordance with the Transfer of Funds Terms and Conditions. <br />Printed Name <br />Printed Name <br />Printed Name <br />Signature <br />Signature <br />Signature <br />Authorization Information* <br />Customer/Company Name: <br />Phone:( ) <br />Authorized Signer: Date: <br />(Signature) <br />Print Name: <br />30-1255 8/14/99 <br />