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If this agreement is sent, you are authorizing Salamat Financial Services to send a pre-authorized eWire to the receiver indicated on your behalf. If the receiver is not already on your account, please complete a new receiver form.

Agent Pre-Authorized Agreement

* Asterisk indicates required field:

Company Identifier: *
Password: *
Email Address:
Receiver Information
Given Name & Surname or Company Name: *
Amount Being Sent:
Currency of Amount Being Sent:
Exchange Rate:
Service Fee:
Amount Owed by Agent: *
Funds will be paid to Salamat Financial Services by:* (MM/DD/YYYY)


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