Wire Transfer Template

 

You requested that payment to you be made by electronic funds transfer (bank wire transfer). In order to properly credit your bank account, please provide the following information, legibly.

 

• Required Fields

 

• Bank Name:

 

 

• Bank Address:

 

 

ABA Routing # (US Banks):

 

• SWIFT Code and/or BIC:

 

• IBAN

 

• Account Name (Not Payee Name):

 

 

Account Holder’s Address:

 

 

• Account Number Additional Information

 

Important

 

Please inquire from your foreign bank (bank outside the United States) if they need to go through a correspondent bank in order to receive a wire transfer from a US Bank. If this is true, then please obtain the following required information regarding your bank’s correspondent bank.

 

For US$ transfers to foreign bank via it’s correspondent bank:

 

Correspondent Bank’s Name:

 

 

Correspondent Bank’s Address:

 

 

SWIFT Code and/or BIC:

 

IBAN

 

Account #

 

 

By my signature below, I confirm that I am the (title)                                                                                                                                                                      of (entity)

 

and as such I have been authorized to provide the

 

nformation above. I understand that the University may seek confirmation of my authority in writing or by phone.

 

 

Signature:                                                                                                                              Date: