REQUEST FOR WIRE TRANSFER
TO:
Rosalynn Feagins
Controller’s Office
Mary Reed Building, A-107
x. 2404; fax#: 3635
FROM:
__________________________
__________________________
__________________________
DATE:
__________________________
Amount:
Amount of wire in U.S. Dollars:
________________________
OR
Amount of wire in foreign currency:_______________________
Bank information:
Name of receiving bank:
________________________
Address of receiving bank:
________________________
________________________
________________________
ABA Routing or Swift Code of bank: ________________________
Recipient information:
Name on receiving account:
________________________
Acct. No or IBAN No:
________________________
________________________
FOAP/Location Code
________________________
Budget Officer signature:
________________________