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REQUEST FOR WIRE TRANSFER

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					MARS Form – Request for Wire Transfer

01/12/10

REQUEST FOR WIRE TRANSFER To allow agencies to receive state or federal funds by electronic transfer by wire instead of check. Agencies who regularly receive federal funds can have a faster turnaround in posting the funds to the state account through the wire transfer option. Universities receive most state funds through the electronic wire transfer. FIELD Agency Number Document Number Originating Agency Date Name Address City, State, Zip Code Document Preparer Work Phone Authorized By: Date Agency Requested Transfer Transfer Amount: $ Document Reference Date Transfer Due at Receiving Bank: Receiving Bank Name Address City, State, Zip Code Receiving Account Name Receiving Account Number ABA Routing Number (if applicable) Enter the name of the bank to receive the wire transfer from the state or federal agency. Enter the street or box number of the bank to receive wire transfer. Enter the city, state, and zip code of bank. Enter the name of the bank account to receive the wire transfer. Enter the account number of the bank account to receive the wire transfer. Enter the American Banking Association (ABA) routing number if needed to complete the wire transfer. Enter the amount to be wire transferred to the agency. Enter the document number of the document to be paid by the wire transfer to the agency. Enter the date the receiving bank will receive the wire transfer from the state or federal agency. Enter current date. Enter name of originating agency. Enter street address or P. O. Box of originating agency. Enter city, state, and zip code of originating agency. Enter name of agency personnel preparing the wire transfer request. Enter the work phone number of the agency personnel preparing the wire transfer request. Authorized agency representatives’ signature. Date document signed by authorized agency representative. DESCRIPTION Enter three-digit Agency identifier. Leave Blank. Nine-digit Document number assigned by ADVANTAGE.

AppsData/KY Project/Working/IMP Team/Pol & Proc/Forms Doc/Rev & Recv/Request for Wire Transfer Page 1 of 2

MARS Form – Request for Wire Transfer

01/12/10

FIELD Attention: (specific person if applicable) Farmers Bank Charge Account Name Charge Account Number State Treasurer Wire Transfer Date Wire Transfer Time Treasurers Electronic Transfer Number Treasury Employee Executing Transfer

DESCRIPTION Enter the name of the specific person to receive the information on the wire transfer at the bank.

Enter the name of the account to be charged at the Farmers Bank (State Treasurer’s account). Enter the account number to be charged at the Farmers Bank.

Enter the date the wire transfer was completed. Enter the time of day the wire transfer was completed. Enter the electronic transfer number used by the State Treasurer. Signature of the State Treasury employee completing the electronic transfer.

AppsData/KY Project/Working/IMP Team/Pol & Proc/Forms Doc/Rev & Recv/Request for Wire Transfer Page 2 of 2


				
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