2009-41Revised 11/2003
OFifth Third Bank
WIRE TRANSFER PIN AUTHORIZATION REQUEST
Date
8/13/2009
Customer Name
CITY OF CLERMONT
Street Address
685 W. MONTROSE STREET
City, State ZIP
CLERMONT, FL 34711
Telephone Number (including area code)
(352) 394 -4081
Authorized Wire Transfer Account Numbers
® ADD F CHANGE ❑DELETE
Representative is authorized for one or more of
the following activities
(you must check at least one)
Representative Name
Telephone
Authorized Limit Per
Transfer ($)
Repetitive
Non-
Re etitive
Callback
Verify
WAYNE SAUNDERS
❑
❑
❑
❑
❑
❑
❑
❑
❑
Customer Signature (Signatory Customer Representative)
e
Printed Name
JO EPH VN ZILE
Title
ADMIN ERVICES DIRECTOR
Date
8/12/2009
FIFTH T HIRD DAN U O NLY
Account Officer Name
Phone
p - - 00-/
Branch Name
kv
Phone
- - OS
Officer Signature
Date
Entered By Date
Verified By Date