Wire Refund Label Names

Submitted by rajesh.rs on

Is your Financial Institution US based?

Group
wirerefund
Sub Heading 1

First Name

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Last Name

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Beneficiary First Name

Sub Heading 4

Beneficiary Last Name

Sub Heading 5

Financial Institution Name

Sub Heading 6

Financial Institution Address

Sub Heading 7

Bank Account Number

Sub Heading 8

Wire Routing Number (Please confirm correct wire number with your financial institution)

Sub Heading 9

Do you have an International Bank Account Number (IBAN)?

Radio Button1

Yes

Radio Button2

No

Radio Button3

Sort Code

Radio Button4

Swift Code

Sub Heading 10

IBAN (Non-US Only)

Sub Heading 11

I hereby accept the terms herein and agree to be bound by such terms.**

Sub Heading 12

Date

Sub Heading 13

Date

Sub Heading 14

Guest Signature

Sub Heading 15

Do you have a Sort Code or a Swift Code?

Sub Heading 16

Swift Code (Non-US Only)

Sub Heading 17

Sort Code (Non-US Only)