Wire Transfer
Non-Recurring Request
Reset Form
Check One:
Domestic Wire
Agency Name:
International Wire
Oregon State University
Date Transfer to Occur:
Agency Number:
58000
Agency Account to be Charged:
58003
Amount of Transfer:
Currency (if other than US $):
Beneficiary:
35 Characters Maximum
Beneficiary Account Number (IBAN):
Beneficiary Street Address:
35 Characters Maximum
Beneficiary City/State/Country:
35 Characters Maximum
Beneficiary Bank Name:
35 Characters Maximum
Beneficiary Bank SWIFT (International Only):
or ABA Routing (Domestic Only)
Beneficiary Bank Street Address:
35 Characters Maximum
Beneficiary Bank City/State/Country:
35 Characters Maximum
Message for Beneficiary:
105 Characters Maximum
Department:
Index or Fund:
Department Signature:
Account Code:
Date:
Printed Name:
Phone
Contact Name:
Phone:
Business Center Invoice Approver:
Approver Signature:
Printed Name:
Date:
Phone:
Business Affairs Use Only - Financial Accounting & Analysis Review
Signature:
Date:
Printed Name
Revised 11/09/2012