Case File
efta-efta00616687DOJ Data Set 9Other1First Bank
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00616687
Pages
1
Persons
0
Integrity
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Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
1First Bank
Transfer Application
(SHADED AREAS FOR BANK USE ONLY)
BRANCH NO.
PREFIX
TEST KEY
DATE
TIME
TRANSFER TYPE:
El
WIRE
.
CABLE
K
DRAFT
K
Mall to Customer
•
Mal to Payee
0
Send to Branch
REP SIGNATURES (Complete appropriate boxes):
KEY
MODIFY
MODIFY
APPROVE
IF TRANSFERRING FOREIGN CURRENCY:
CONTRACT NO
VALUE DATE
CONVERSION RATE
CONVERTED BY (Initials)
TRANSFER AMOUNT:
FOREIGN CURRENCY (TYPE AND AMOUNT)
TRADER'S NAME
U.S. DOLLARS
$
71,012.00
NOTE'
ADDITIONAL FEES
$
•
Foreign currency amount multiplied by the exchange rate = U.S. dollar Amount
• U.S. Dollar amount divided by the exchange rate = Foreign Currency Amount.
TOTAL AMOUNT
6
71,01200
METHOD OF PAYMENT:
INTERMEDIARY CORRESPONDENT BANK: (II necessary)
DEBIT ACCOUNT NO.
DEBIT BRANCWDEPT. NO.
08
ABA ROUTING NO./SWIFT CODE
NAME/ACCOUNT TITLE
LSJ, LLC
BANK NAME
MAIUNG ADDRESS:
do Financial Trust Co., Inc. 6100 Red Hook Quarter, B3
ADDRESS
PHYSICAL ADDRESS:
6100 Red Hook Quarter, 83
CITY. STATE. ZIP CODE. COUNTRY
St. Thomas, VI 00802-1348, USA
CRY, STATE, ZIP CODE, COUNTRY
TO: PAYEE/BENEFICIARY'S BANK
FOR: PAYEE/ACCOUNT OF ULTIMATE BENEFICIARY
lift
ACCOUNT NO.
BANK NAME
Darby Bank & Trust
NAME/ACCOUNT TITLE
TSG Technologies, Inc.
ADDRESS
ADDRESS
327 Eisenhower Dr. Ste. 100
CITY, STATE, ZIP CODE, COUNTRY
Savannah, GA, 31406, USA
CITY, STATE, ZIP CODE, COUNTRY
Savannah, GA, 31406, USA
ORIGINATOR REFERENCE:
BENEFICIARY REFERENCE:
I
I
I
I
I
I
I
I
I
I
I
l
i
l
t
I
I
I
I I I I I
I I I I I
I
I
SPECIAL INSTRUCTIONS: (Optional)
Please email Fed. Reference number to Emad Hanna at
THE UNDERSIGNED AGREES TO THE CONDITIONS ON THE REVERSE SIDE OF THIS APPUCATION.
CUSTOMERS TELEPHON
DATE OF APPLICATION
6/27/2007
CUSTOMER
IGN
R
CUSTOMERS SIGNATURE (If Applicable)
CUS
ME
T
ER REQUEST: (Complete appropriate boxes)
O
FAX
IN PERSON O
PHONE
0
MAIUMESSENGER
I.D. USED (Do not leave blank)
ELEPHONE/FAX
K
AGREEMENT ON FLE
K CALL-BACK IF OVER S LIMIT:
m
m
ONE TIME ONLY
TRANSACTION
Ill By_
.
U Spoko to
U Time
HOLD PLACED
_
_
_
_
TAKEN IN BY (Print Name)
INITIALS
TEST KEY CALCULATED BY (If different than taken in by)
I INITIALS
BRANCH AUTHORIZED SIGNER (Print Name)
BRANCH TELEPHONE NO.
(
)
-
BRANCH AUTHORIZED SIGNATURE
NNAN-2196.0802
EFTA00616687
Technical Artifacts (10)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Phone
802-1348SWIFT/BIC
BENEFICIARYSWIFT/BIC
CONTRACTSWIFT/BIC
CURRENCYSWIFT/BIC
PHYSICALSWIFT/BIC
ULTIMATEWire Ref
REFERENCEWire Ref
ReferenceWire Ref
TRANSFER AMOUNTWire Ref
Transfer ApplicationForum Discussions
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