Wire Transfer Request Form
200 Piedmont Avenue, Suite 1202 West Tower, Atlanta, GA 30334 Phone (404) 656-2168, Fax (404) 657-9066
This form should be sent to OTFS before 11:00 A.M. for same day wire.
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Requesting Agency Name:
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Authorized Wire Transfer Requestor:
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Contact Phone Number:
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Bank Name:
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Bank ABA (Routing Number):
Or Intermediate ABA:
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Bank Account Number:
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Bank Account Name:
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Customers Address:
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City, State and Zip Code:
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Has AP wire payment voucher passed the budget check?
Yes
No
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AP Voucher ID:
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Vendor Name:
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Reason for Payment:
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Amount to be wired:
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Scheduled Wire Date:
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Addenda Data/Reference:
By placing my initials below, I certify that the above information is accurate and that I am an authorized approver (Director/Manager) for same day wires.
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Approved by:
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Date:
You will receive confirmation of receipt from the OTFS Team. If no confirmation is received by 11:30 A.M. please contact Amy Stevens at 404-657-4204 or Lisa Hoover at 404-657-2094.
Office of Treasury and Fiscal Services Use Only
Date Received:
Date Wired:
Wired By:
Repetitive Code:
OTFS Form: 100-F
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Indicates Response Required