Wire Transfer Request Form - Rcuh

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Attachment 43
WIRE TRANSFER REQUEST FORM
This form must be typed. ALL fields are required. Forms with hand-written information and/or
missing required information will be returned to the Fiscal Administrator. Refer to Policy 2.706 for
details on wire transfers.
WIRE PAYMENT INFORMATION
1
Domestic Wire
2
Foreign Wire
3
Currency Type
(Select a currency)
Amount
6
Beneficiary Bank Account Name
Beneficiary Address
City and State/Country
7
Beneficiary Bank Account Number
Bank Name
Bank Address
City and Country
8
Bank SWIFT Code
9
Remittance/Reference Information
PROJECT INFORMATION
Charge the Bank Fee to: Project Number
Budget Category
Wire confirmation will be faxed to the Fiscal Administrator
FA Name
FA Fax Number

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