Wire Transfer Request (LCFI-36)

Stage

Detailed Information

To: Kaden Colborn, Irene Josey, Todd Sims
Treasurer's Office

FROM:

DATE:

YOUR EMAIL:

RE:

(briefly describe the purpose for the transfer request)

Please transfer $

Due Date to Bank:

To (Vendor Name)

Expense – GL Key, GL Object,
JL Key, JL Object (KOKO)

Amount

fopal1

TOTAL $

Vendor Information

Attach Supporting Documentation

Vendor Contact Info

Contact: Name:

Phone Number:

Vendor Verification Check

Department
Date Checked

Finance AP
Date Checked

initials

Add Banking Information

Bank Name

ABA #

ACCT #

Name on Acct

Bank Address:

Authorized Department Approver

Authorized Name:

Authorized Email:

Wire Transfer Request:

Approve

Reject

Reject Reason:

Date:

Authorized Department Signature

Finance Signature Approvals

FAEMAIL

Wire Transfer Request:

Approve

Reject

Reject Reason:

Date:

Finance Director or Designee

Accounts Payable Signature Approvals

Account Payable Email:

Wire Transfer Request:

Approve

Reject

Date:

Reject Reason:

AP Initials

Treasurer's Signature Approval

Treasurer Email:

Wire Transfer Request:

Approve

Reject

Reject Reason:

Date:

Treasurer Initials

Treasurer's Confirmation

Treasurer Email:

Date:

Reject Reason:

Attach Wire Transfer Reference Document

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Confirnation Email Initials

PDF

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