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WIRE REQUEST FORM: SEND DOLLARS FROM YOUR U.S. ACCOUNT TO AN ISRAELI BANK
After you complete this form, a final version of your wire request will be emailed to you.
Print that email and have all account owners sign it. Fax the form to 02-624-2789.
What email address should we send the form to now?
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Please enter your account name
exactly as it appears on your monthly statement.
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Enter your account number here.
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Enter the phone number(s) where we can reach you
now in case there is a problem.
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Amount to wire (U.S. dollars)
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All cash in the account minus transfer fees, and close account
Other (enter dollar amount)
Other (enter dollar amount)
Amount in words
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Reason for transfer of funds (according to U.S. Patriot Act,
further information is required before wires can be sent)
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In compliance with the US Patriot Act Money Laundering Requirements Act we may
request additional documentation and/or information of the receiver of your wire.
This may include a contract or other related material or correspondence.
Profile Investments, Portfolio Resources and NFS has the discretion of refusing a
money transfer if proper backup is not provided and/or if there are discrepancies with your request.
Gift to family member
Mortgage/rent payment
Pay household expenses
Real estate purchase
Supplement income
Travel
Closing account
Other
Other
What is your relationship of person
to whom you are sending the gift?
Is the money being sent to an account with the
same name as your account with us?
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Yes. I am sending the money to my own account.
No. I am sending the money to someone else.
(This field only needs to be completed if the money is being sent to
someone other than you.) Please enter ALL OF THE FOLLOWING:
Address of recipient, date of birth of recipient, occupation of recipient,
Passport # & country issued OR National ID # and country issued
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This information is only required if the money is being sent to someone other than you.
What is the name of the Israeli bank where the money is going?
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CLICK HERE TO SELECT YOUR BANK FROM THE LIST BELOW
BANK OF JERUSALEM (Correspondent: Bank of New York Mellon, ABA 021000018) Bank of Jerusalem a/c #8901358215
FIRST INTERNATIONAL BANK OF ISRAEL (Correspondent: Citibank, ABA: 021000089, FIBI Head Office, Tel Aviv a/c # 10962756)
HAPOALIM (Correspondent bank: Bank of NY, ABA: 021000018, Bank HaPoalim a/c # 803 317 7756)
ISRAEL DISCOUNT BANK (Correspondent bank: Israel Discount Bank of NY, ABA: 026009768, Israel Discount Bk a/c #50008)
LEUMI (Correspondent bank: JP Morgan Chase Bank, ABA: 021000021, Bank Leumi a/c # 001 1 4 31244)
MASSAD (Correspondent bank: Bank of NY, ABA: 021000018, Bank HaPoalim a/c # 803 317 7756, BNF: Bk Massad, Branch 164)
MERCANTILE DISCOUNT (Correspondent: Israel Discount Bank of NY ABA: 026009768, Merc Discount Bk Tel Aviv a/c # 50104)
MIZRAHI (Correspondent bank: JP Morgan Chase Bank, ABA: 021000021, Bank Mizrahi a/c #544723637)
OTSAR HAHAYAL (Correspondent bank: Bank of NY, ABA: 021000018, SWIFT # IRVT US 3N)
U-BANK (Correspondent bank: JP Morgan Chase Bank, ABA: 021000021, U-Bank a/c #001-143-6094)
UNION BANK OF ISRAEL (BANK IGUD) (Correspondent: JP Morgan Chase Bank, ABA: 021000021, Union Bk a/c #0011438207)
YAHAV (Correspondent bank: Bk of NY, ABA: 021000018, Bk Mizrachi a/c # MIZBILT, BNF: Bk Yahav a/c byahili1)
What is the name of the account at the Israeli bank?
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What is the BRANCH number of the Israeli bank?
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What is the ACCOUNT number of the account at the Israeli bank?
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What is the ADDRESS of the Israeli bank?
Enter any other reference details that may be required
for this money transfer (you may leave this field blank).
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= Input is required