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: 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          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          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.

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:

7/4/2008 3:28:32 PM

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

TO

Domestic ($15 Wire Fee)

International ($50 Wire Fee)

Wire amount
Wire fee
Total Charge

Beneficiary		Beneficiary's Bank

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

Additional Information
____________________________		____________________________		____________
Customer Signature		American Bank Representative		Authorization #

Member FDIC

Wire Transfer Disclosure

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