Fillable UNIVERSITY OF ALASKA FOREIGN WIRE REQUEST FORM (University of Alaska)

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UNIVERSITY OF ALASKA FOREIGN WIRE REQUEST FORM (University of Alaska)

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UNIVERSITY OF ALASKA
FOREIGN WIRE REQUEST FORM
NO ELECTRONIC SIGNATURES SUCH AS DOCUSIGN ARE ALLLOWED. THIS DOC CONTAINS PII. IN ORDER FOR
FUNDS TO BE SENT, AUTH SIGNER MUST APPROVE AND SUBMIT THIS REQUEST VIA EMAIL TO UA-CASH.EDU.
*Indicates required Field
03/20
UA AUTHORIZATION:
*Requested by:
*Date:
_________________
Requestor must sign and be different than authorized signers
*
Authorized by:
*Date:
*
Authorized Signer call back phone#:________________________
TRANSACTION INFORMATION (Use USD or Foreign Currency):
*USD Amount: ____________________________ *Transfer Date: __________________________
*Foreign Currency Amount: ____________________ *3 Letter Currency Code: __________________
BENEFICIARY/VENDOR INFORMATION:
CASH MANAGEMENT USE ONLY
*Verified/Approved:
Date:
From Bank Account #:
JV#:
*U.S. Department of the Treasury OFAC verified ______________________________
*
Vendor/Payee Name:
*
LAST 4 digits of Vendor/Payee Account #:
Has acct # changed for this
vendor? Circle one: Yes/No
*
Vendor/Payee Address:
*US Financial Institution Name:
*US Financial Institution Routing #:
Additional Info/Reason:
Reference: _________________________________________*Banner # for wire fee: _________________
FOREIGN FINANCIAL INSTITUTION (Final destination financial institution where funds are received and
posted to vendor/beneficiary account):
*Foreign FI Name:
*Address:
*SWIFT Code:
Other:
Requestor phone #:_______________
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UNIVERSITY OF ALASKA FOREIGN WIRE REQUEST FORM (University of Alaska)

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Completed 28 August 2020

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