Wire Transfer Request Form - Excel

							                                                                                                                                                  INSTRUCTIONS




                                                                                                                            Date Enter the current date MM-DD-YY.


Wire Transfer Request Form                                                                                                 Name Enter the beneficiary name (name on account).


                                                                                                                     Bank Name Enter the beneficiary bank name.


                                                                                                                  Bank Address Enter the beneficiary bank address.


To be completed by department:                                                 Date                      Bank Account Number Enter the bank account number that the wire is to be deposited into.
Beneficiary Name
Bank Name                                                                                                           SWIFT Code Should be 8-11 characters long, necessary for foreign wires.
Bank Address
Bank Account Number                                                                                                        IBAN Can be up to 30 digits long. IBAN's differ for each country. Not always necessary.
Swift Code/IBAN
Intermediary Bank                                                                                            Intermediary Bank Not always necessary.
Other Information:
                                                                                                              Other Information Enter any other information that you have to help ensure transmission of the wire.


Please Itemize:                                                                                                     Description Enter description of wire. Original receipts/invoices/email correspondence must
                     Description*                              12digit account number       Amount                                be attached.
                                                                 X-X-XXXXX-XXXXX
                                                                                                                        Account Enter the twelve-digit account number X-X-XXXXX-XXXXX to charge.


                                                                                                                        Amount Enter the amount to be paid for each line item. Original Receipts/invoices/email
                                                                                                                                  correspondence must be attached. Also identify the people, place, and purpose for
                                                                                                                                  meal and entertainment expenses.


                                                                                                                           Total Enter the total amount to be paid. The wire will be issued for this amount.
*Receipts/invoices must be attached                                          Total    $              -
                                                                                                                      Purchaser The signature of the purchaser is required here.
Signatures                                                                    Phone          Date
                                                                                                                 Budget Officer The signature of the budget officer is required here.
Purchaser                                                                                                                         The Wire Transfer Request Form will not be processed without the budget officer's
                                                                                                                                  signature.
Budget Officer
                                                                                                         Vice President/Provost The signature of the Vice President/Provost is required if more than $25.00 of the
Vice President/Provost (if unsupported expenditure > $25.00)                                                                      Wire Transfer Request lacks supporting documentation.


                                                                                                                      Important While Calvin does not charge an administrative fee to process wires, the direct fee
                          Return completed form to Accounts Payable                                                               administered by the bank is charged to the department requesting the wire. We do not
          For Accounts Payable Use:                                                                                               always know what the exact wire fee will be until the wire is complete. Please contact us
        Approval for Payment           Initials           Date                                                                    if you wish to know what the approximate wire fee might be.
                              A/P: _______              ________        Date received A/P
                         Controller: _______            ________         Voucher number
                                                                                                                              Return Completed form to Accounts Payable