REQUEST FOR WIRE TRANSFER



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.

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|FIELD |DESCRIPTION |

|Agency Number |Enter three-digit Agency identifier. |

|Document Number |Leave Blank. Nine-digit Document number assigned by ADVANTAGE. |

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|Originating Agency | |

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|Date |Enter current date. |

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|Name |Enter name of originating agency. |

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|Address |Enter street address or P. O. Box of originating agency. |

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|City, State, Zip Code |Enter city, state, and zip code of originating agency. |

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|Document Preparer |Enter name of agency personnel preparing the wire transfer request. |

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|Work Phone |Enter the work phone number of the agency personnel preparing the wire transfer request. |

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|Authorized By: |Authorized agency representatives’ signature. |

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|Date |Date document signed by authorized agency representative. |

|Agency Requested Transfer | |

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|Transfer Amount: $ |Enter the amount to be wire transferred to the agency. |

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|Document Reference |Enter the document number of the document to be paid by the wire transfer to the agency. |

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|Date Transfer Due at Receiving Bank: |Enter the date the receiving bank will receive the wire transfer from the state or federal agency.|

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|Receiving Bank | |

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|Name |Enter the name of the bank to receive the wire transfer from the state or federal agency. |

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|Address |Enter the street or box number of the bank to receive wire transfer. |

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|City, State, Zip Code |Enter the city, state, and zip code of bank. |

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|Receiving Account Name |Enter the name of the bank account to receive the wire transfer. |

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|Receiving Account Number |Enter the account number of the bank account to receive the wire transfer. |

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|ABA Routing Number |Enter the American Banking Association (ABA) routing number if needed to complete the wire |

|(if applicable) |transfer. |

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|Attention: (specific person if applicable)|Enter the name of the specific person to receive the information on the wire transfer at the bank.|

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|Farmers Bank | |

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|Charge Account Name |Enter the name of the account to be charged at the Farmers Bank (State Treasurer’s account). |

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|Charge Account Number |Enter the account number to be charged at the Farmers Bank. |

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|State Treasurer | |

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|Wire Transfer Date |Enter the date the wire transfer was completed. |

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|Wire Transfer Time |Enter the time of day the wire transfer was completed. |

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|Treasurers Electronic Transfer Number |Enter the electronic transfer number used by the State Treasurer. |

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|Treasury Employee Executing Transfer |Signature of the State Treasury employee completing the electronic transfer. |

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