Rev 06/16
Louisiana State University
Office of Accounting Services
Accounts Payable & Travel
217 Thomas Boyd Hall
WIRE TRANSFER REQUEST AS493
(Domestic or International)
Request Date ______________________ Payment Type ACH Wire
Type of Wire Domestic International
Beneficiary Name ________________________________ Amount ________________________
For a Domestic Wire:
For an International Wire (Beneficiary Bank): Intermediary Bank:
Special Instructions __________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Requested by: ______________________________________ Date: ___________________________
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FOR ACCOUNTING SERVICES USE ONLY
JP Morgan Access
Supplier Invoice #
Bank Transaction #
Date & Time of Wire
Initiated by
Bank Name
Bank Routing
Code
Account #
State
Zip
Bank Name
Swift Code/BIC
Account #
IBAN #
Province
Country
Bank Name
Swift Code/ABA