WIRES_1_

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					DOMESTIC WIRE TRANSFERS
The following information must be provided with your invoice if you would like payment by wire transfer (information only needed 1 time) DATE _________________________________________________________ AMOUNT ______________________________________________________ REQUESTOR___________________________________________________

BANK INFORMATION IS THIS A NEW ACCOUNT? YES ___
PRIMARY BANK:(required) BANK NAME _____ ______________________________________________ ADDRESS (minimum = city and state)_______________________________ _______________________________________________________ ABA ( 9 DIGITS) ________________________________________________

NO ___

BENEFICIARY: (required) ACCOUNT NUMBER_____________________________________________ NAME __________________________________________________________ ADDRESS _______________________________________________________ ________________________________________________________ DETAILS OF PAYMENTS ________________________________________ _________________________________________________________________


				
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