Treasury Operations
Money Movement Services
WIRE New Model Set-up Request
For ACH payments please, contact Charles Sinex in Accounts Payable.
Date
Person Making Request
Department
Phone Number
E-mail Address
WIRE REQUEST
Account in the Name of
Bank Name
Bank City, State
Account Number
Routing Number (ABA)
Purpose/Additional Information
APPROVAL
Account Supervisor (Printed)
Account Supervisor (Signed)
Fiscal Officer (Printed)
Fiscal Officer (Signed)
Send to Poplars 532 ATTN: C. Sinex
for Accounts Payable Approval
Please direct any questions to C. Sinex.
After all approvals have been obtained, Accounts Payable should forward the completed form to:
Treasury Operations, Poplars 205, IUBL
New Model Request circle one
This box is for Treasury use only
Director Approval_______Date_______
Model Creator__________Date_______
Model Approver________Date________
Model Number Assigned___________
Maximum Amount $
FIS________Date_______
Form________Date_______