Effective August 11, 2005, ________________________________________________, a financial institution operating in Florida, agrees to voluntarily waive the wire-transfer or processing fees to our customers for wire-transfer payments for Holocaust-related reparations or restitution. Upon receipt of a written request and reasonable documentation from our customers, we will waive all of our fees associated with processing these wire-transfer payments.
Name of Institution (please print)________________________________________________
Signatory (please print):_______________________________________________________
Title (please print):___________________________________________________________
Signature:__________________________________________________________________
Contact Telephone Number:___________________________________________________
Information to be posted on Website (please print)
Name of Financial Institution:
__________________________________________________________________________
Address for Sending Written Requests:
__________________________________________________________________________
City____________________________ State________________ Zip___________________
Contact Telephone Number for Questions (preferably toll-free):_______________________
Send this form to:
Lynn Grossman
Florida Department of Financial Services
200 E. Gaines Street
Room 624G
Tallahassee, Fl 32399-4205
850-413-4160