wire transfer request form by housework

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									                                    WIRE TRANSFER REQUEST FORM

            This wire transfer form must be confirmed by the beneficiary's Financial Institution.


            Date

Purpose of Wire Transfer



Beneficiary Bank Name                                                   ABA Number



Beneficiary Bank Address (Street/City/State/Zip; Country)




Beneficiary Name



Beneficiary Account Number



Beneficiary Address (Street/City/State/Zip; Country)




Message/Information/Instructions to Beneficiary



AMOUNT                                           + 15.00* = Total $
                                                * Wire Transfer Fee


This Wire Transfer request form must be included with your request for payment.

Return to   Cyndi Thornton, Financial Services
Phone       506-452-6339
Fax         506-453-4572
E-mail      cthornto@unb.ca

								
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