Advanced Funds Transfer (AFT) Authorization Form
Please complete the Advanced Funds Transfer (AFT) Authorization Form to authorize your funds transfer. Do not include sensitive account or personal identifiers. Only the last 4 digits of any account or reference number should be provided where requested.
Full Name of Authorizing Person
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Recipient Name
*
First Name
Last Name
Recipient Reference (Last 4 Digits Only)
*
Transfer Amount (USD)
*
Purpose of Transfer
*
Transfer Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Instructions (Optional)
Authorized Signature
*
Authorize Transfer
Authorize Transfer
Should be Empty: