Wire Transfer Request - Domestic/International

Wire Transfer Instructions 1. Complete all fields on this form. 2. Print this form and sign where indicated. 3. Click on the "Wire Transfer Disclosure" to read and print the disclosure information. 4. Wire transfer requests $50,000 or less per day: Online Banking Customers You may fax the completed and signed form to 610.289.3326. In addition, for security purposes, we request that you also send us a Secured Message. A Secured Message can be sent by signing on to pcbanker.com and clicking on the "Mailbox" link. This Secured Message should include the name of the bank you are wiring to, the bank's routing #, the dollar amount of the wire and an indication that you have also faxed your wire request. Non-Online Banking Customers You may send your completed and signed form to:          American Bank          Attn: Customer Service          4029 W. Tilghman St.          Allentown, PA 18104 5. Wire transfer requests over $50,000 We do not accept fax wire requests for amounts over $50,000. You may deliver the completed and signed form in person or send by U.S. Mail or     Overnight Delivery to:          American Bank          Attn: Customer Service          4029 W. Tilghman St.          Allentown, PA 18104 6. The Bank reserves the right to employ telephonic call-back verification prior to processing any wire request to ensure authenticity by contacting you at the daytime number provided on this form. If we are unable to contact you, this may delay your request being sent.

Wire Request Transfer Form I hereby authorize and direct American Bank to execute the following Wire Transfer subject to the availability of funds, the Bank's fee schedule and terms and conditions stated at the bottom of this page.

FROM

Date:

7/31/2010 11:38:34 PM

	Customer
	Name
	Address
	City		State		Zip
	Deposit Account Number
	Daytime Telephone Number

WIRE TYPE & AMOUNT (Choose One)

Domestic
Wire Amount $
Wire Fee	$15.00
International - Convert to Foreign Currency
Specify Foreign Currency (i.e. Canadian Dollar, Swiss Franc, Euros):
Is this the US Dollars or the Foreign Currency Amount?
Wire Amount $
Wire Fee	$50.00
International - Send in US Currency
Wire Amount $
Wire Fee	$50.00

TO
Beneficiary		Beneficiary's Bank

Name		Name
Address *		Address *
City		City
State		State
Zip		Zip
Country		Country
Account Number		ABA #

* A physical street address is required. PO boxes will not be accepted.

Reason for the Wire:
	This field is required if the wire is greater than $1.5 million.
Additional Information for International Wires
Swift Code:
IBAN/CLABE:  (if applicable)
Additional Information:
By signing below you acknowledge that you have reviewed the information on this form and agree that any inaccuracies or omissions of information on this form may delay the processing time of the wire transfer. You further understand and agree, that due to fluctuations in the foreign exchange rate, international wire transfers for amounts other than U.S. currency, will be estimated and the estimated amount will be withdrawn from your account. In addition, you further authorize American Bank, upon confirmation of the foreign exchange rate, to adjust (+/-) your account accordingly.
_________________________________		_________________________________		____________
Customer Signature		American Bank Representative		Authorization #

Member FDIC

Wire Transfer Disclosure

Privacy Policy  /  Security  /  Disclosures  /  Site Map service@pcbanker.com  /  888.366.6622 / Telephone Banker: 888.960.5050 Headquarters: 4029 West Tilghman Street, Allentown, PA 18104 Copyright © 2010 American Bank. All Rights Reserved. This page was retrieved at 11:38:34 PM on July 31, 2010