Fund Transfer Authorization

Fund Transfer Authorization

Company Name:
The following information is required for every file transfer template. Photocopy and fill out this worksheet as needed.
Transfer ID:		Recurring
Additional Approval Type:
Display Group:
Default Amount:
Amount Increments:
Minimum Amount:
Maximum Amount:

From Institution R/T Number:		To Institution R/T Number:
From Account Type:		To Account Type:
From Account:		Account Type:

ACH In

From Account Name:
Addenda:

ACH Out

To Account Name:
Addenda:

Tax payment

Tax Type Code:
Tax Information ID 1:
Tax Information ID 2:
Tax Information ID 3:

Domestic Wire

To Institution Name:
To Institution Address:
To Institution City, State, Zip:
Beneficiary Institution R/T Number:
Beneficiary Institution Name:
Beneficiary Institution Address:
Beneficiary Institution City, State, Zip:
Beneficiary Name:
Beneficiary Address:
Beneficiary City, State, Zip:

Foreign Wire

To Institution Name:
To Institution Address:
To Institution City, State, Zip:
Beneficiary Institution R/T Number:
Foreign Beneficiary Institution R/T Number:
Beneficiary Institution Name:
Beneficiary Institution Address:
Beneficiary Institution City, State, Zip:
Beneficiary Name:
Beneficiary Address:
Beneficiary City, State, Zip:

Bill Payment

Vendor Name:
Vendor Number:

Today's Date: