Latvian Credit Union

Wire Transfer Request Form

Member's Name: __________________________

Member's Address: ____________________________________________________

Member's LCU Account Number: ____________

Wire Amount in U.S. Dollars:      $____________

Recipient's Name in Latvia: ________________________ (must be exact name on bank account in Latvia)

Recipient's Address in Latvia: _______________________________________

Recipient's Latvian Bank Name: ______________________________________

Recipient's Latvian Bank Account Number:______________________________

Latvian Bank's Address: ______________________________________________

Latvian Bank's Branch Name (if applicable) : _____________________________
  • Latvian Banks $12 FEE :

  • ALL OTHER BANKS : $45 FEE

    Latvian Credit Union CANNOT GUARANTEE international wires.
    Complete and correct wiring instructions are the sender's responsibility.

    Sender's Signature: ________________________   Date Signed: ____________

    Additional Reference Information (if applicable):______________________________


    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ For Office Use Only ~~~~~~~~~~~~~~~~~~~~~~~

    MIDSTATES:   Date____________                WO_________                      Fee________        CHBK____

    COMP: SF_______                   SW___________               CTR? [   ]No [   ]Yes          Initials_______

    • * Fees subject to change without notice *
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