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Heinsohn's Country Store
financing available!

In Our Family since 1920
For Old Time Country Values!

1-800-300-5081
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WIRE TRANSFER INFORMATION FOR HEINSOHN'S COUNTRY STORE

COMPLETE ALL MAROON AREAS WITH YOUR INFORMATION IN ENGLISH/Complete todas las áreas GRANATE CON SU INFORMACIÓN EN INGLÉS
Wire Transfer Request/Solicitud de Transferencia de Fondos
Today's Date/Fecha de Hoy Fax # of Your Financial Institution
/Número de fax de su entidad financiera
Customer Information/Informacion de Cliente
Name as it Appears on your Account
/Nombre como Aparece en su Cuenta		Account Number/Numero de Cuenta
Final Destination of Funds/Destino Final de los Fondos
Currency Type/Tipo de Monedo o DivisaAmount/Monto
U.S. Dollar
Written Amount/Monta Escripto
.
Receiving Institution/institucion ReceptoraABA Number/Numero de ABA SWIFT Code/Codigo de SWIFT
INDUSTRY STATE BANK113111077
City/CuidadCountry/Pais
16886 FORDTRAN BLVD, INDUSTRY, TEXAS 78944U.S.A.

Beneficiary Institution/institucion el beneficiarioABA Number/Numero de ABA SWIFT Code/Codigo de SWIFT
INDUSTRY STATE BANK113111077
City/CuidadCountry/Pais
16886 FORDTRAN BLVD, INDUSTRY, TEXAS 78944U.S.A.

RECEIVERS NAME AND ADDRESS/Nombre del destinatario y dirección delAccount Number/Numero de Cuenta <>/td>
HEINSOHN'S STORE
1560 FM 109
NEW ULM, TEXAS 78950 		203140660
Signature/Firma
.
.
Name of Signer/nombre y Apellido del Beneficiario
Click to Print This Page/Haga clic para imprimir esta página
FAX THE COMPLETED PAGE TO YOUR FINANCIAL INSTITUTION./FAX LA PÁGINA DE LLENO A LA INSTITUCIÓN FINANCIERA.