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)
Please direct any questions to Treasury Operations.
After all approvals have been obtained, departments 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_______