Business Office - Suite 8401 REQUEST FOR WIRE TRANSFER Instructions: 1. Complete this form online and provide all the information requested (incomplete and handwritten forms will not be processed). 2. Print a copy of your completed form and forward it to the Business Office (Room 8401), along with your Payment Request Form and the supporting documentation. Please be aware that no specific date can be guaranteed for foreign wires. Department Name: _____________________________________________________________________________________ Department Contact Person: _________________________________________ Phone Number: ______________________ Beneficiary (Payee) Information (The payee name must match the name on the bank account to be credited) : Name: _____________________________________________ Email address: ____________________________________ Address: ____________________________________________________ State: __________________________ Zip Code: _______________ City: _______________________________ Country: __________________________________ Amount of Payment: __________________________________ (USD Only) Beneficiary Bank Information: Bank Name: ___________________________________________________________________________________________ Bank Address: ____________________________________________________ City: _______________________________ State: __________________________ Zip Code: _______________ Country: __________________________________ Type of Wire (Select One): Domestic Wire: ABA #: _______________________________ Account # (no spaces/dashes): _______________________________ International Wire: SWIFT/BIC Code: ________________________________________________________________________________ IBAN/Acct # (IBAN required for EURO countries): ____________________________________________________________ Memo Information (invoice #, notification info, descriptions, etc.): ______________________________________________________ Check if Intermediary Bank Information Provided Intermediary Bank Name: _________________________________________________________________________ Intermediary Bank Address: _______________________________________________________________________ Account #: ______________________________ ABA # / SWIFT / BIC Code _________________________________ Approval: Fund Manager’s Name: ____________________________________________________________________ Fund Manager’s Signature: __________________________________ Date: ________________________ For Graduate Center Business Office Use Only: Initiated By: Signature: ___________________________________________ Date: ________________________ Approved By: Signature: ___________________________________________ Date: ________________________