Receiving Bank: Silverton Bank 

Receiving Bank routing number: 061003415

Receiving Bank address:

3284 Northside Parkway NW
Atlanta, GA 30327

Beneficiary Bank: Bartow County Bank 

Beneficiary Bank routing number: 061102439 

Beneficiary Bank address:

301 E. Church St .
Cartersville GA 30120  

For Credit to: Customer's name: ______________________

Customer's account number: ________________________