I hereby appoint United Pacific Bank my agent for the purpose
of effecting a payment per the details given on the face of this order. When I
direct the funds received from me to be remitted in foreign values, the Bank
may, in its discretion, convert said funds received from me into said foreign
values at the Bank's selling rate on the day such funds are received, unless I
direct the Bank in writing to charge an account maintained by me in the foreign
funds to be remitted for the amount of the remittance.
Bank's statement in writing that it has made such a conversion referred to above
shall be conclusive, and in such a case, the order in this instrument shall be
construed as an immediate purchase by me of the amount of said foreign funds at
my sole risk. The said remittance may be made by the Bank through its customary
channels, and the Bank is absolved from any and all liabilities for loss arising
from any cause beyond its control, including, but not limited to the following:
(1) The act, failure be neglect of any agent or correspondent
selected by the Bank for the remittance thereof:
Any delay, error, omission or default of any mail, telegraph, cable or wireless
The acts or edicts of any government or governmental agency or other group or
groups exercising governmental powers, whether de jure or de facto.
When a Request contains a name and account number, payment may
be made by Bank and/or by other banks to which a Request is forwarded based
solely on the account number even if the acco6nt number identifies a beneficiary
different from the beneficiary named by Customer. Customer acknowledges that
Bank and other banks to which a Request is forwarded may rely on any bank
identification number supplied by Customer as a means to identify any other
bank, even if the identification number is different than the bank named by
Customer acknowledges that payment orders may be received by
us and may be executed by us using Federal Reserve Communication System (Fedwire),
and will be subject to Regulation J and its accompanying Subpart B.
Bank shall be under no obligation to obtain the receipt of the payee. The Bank
on request, will use its best efforts to trace payment. No request for tracing
shall be made prior to three weeks from date of this order.
Bank shall not be under no liability to make any refund prior to receipt by it
of continuation or order of cancellation from the correspondent, agent or
subagent engaged by the Bank to effect the transmittal and in the case of funds
already converted, only on the basis of the Bank's buying rate on the day refund
is made less the expenses of the Bank, its correspondents and agents. The Bank
may discharge said liability, if any, by assigning to me its interest in any
credit which may be established as a result of this order with its
correspondent, agent or subagent.
| PAYING BANK
| ABA REFERENCE
| ACCOUNT NO.
| ACCOUNT NO.
IN PAYMENT OF THE ABOVE
REMITTANCE FOR COST
PLUS ALL BANK CHARGES:
CASH ATTACHED (Subject to authorized receipt issued by Bank)
CHECK IN YOUR FAVOR NO._________________________
(Subject to final payment in good
DRAWN ON __________________________________
PLEASE DEBIT MY/OUR ACCOUNT NO. _______________
BY SIGNING THIS WIRE TRANSFER APPLICATION AND INSTRUCTIONS, I/WE AGREE
TO ALL TERMS AND CONDITIONS SET FORTH. PLEASE EFFECT PAYMENT ACCORDING
TO MY/OUR INSTRUCTIONS.
WIRE FEE $______________________________
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