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[{"$nulls":36},"3401 FR.03 Request for Wire Transfer"]
[null,null,"DO NOT USE THIS FORM FOR ANY PAYMENT THAT CAN BE MADE BY CHECK OR ACH"]
[null,null,"Treasury Use Only"]
[null,null,"Bank Conf#",{"$nulls":11},"RW#",{"$nulls":11},"Wire Log#"]
[]
[]
[null,null,"Vendor Number",{"$nulls":11},"Tax Office Use Only",{"$nulls":11},"Accounts Payable Only                                 Total Verified by (initials)"]
[null,null," ",{"$nulls":11},"Taxes Withheld "]
[{"$nulls":14},"Percent Withheld:                                     Adj Amt Due:"]
[null,null,"Payment Due Date (MON-DD-YYYY)",{"$nulls":23},"Total Amount Due"]
[null,null," ",{"$nulls":23}," "]
[null,null,"Date of Request:",{"$nulls":23},"                ","U.S.Dollar",{"$nulls":4},"Foreign Currency"]
[null,null,"Bank Name",{"$nulls":10}," ",{"$nulls":17},"Please Select:"]
[null,null,"Bank Address",{"$nulls":10}," ",{"$nulls":18},"Euro Note "]
[{"$nulls":13}," ",{"$nulls":18},"UK Pound"]
[{"$nulls":13}," ",{"$nulls":18},"Swiss Franc"]
[null,null,"ABA Number ",{"$nulls":29},"Canadian Dollar"]
[null,null,"or Swift Number if Foreign ",{"$nulls":10}," ",{"$nulls":18},"Japanese Yen "]
[{"$nulls":32},"Other:"]
[null,null,"Vendor Bank Account Number"]
[null,null,"(IBAN required for Europe)",{"$nulls":10}," "]
[null,null,"Vendor Name ",{"$nulls":10}," ",{"$nulls":15},"Treasury Use Only"]
[{"$nulls":13}," ",{"$nulls":15},"Exchange Rate:"]
[null,null,"Vendor Address",{"$nulls":10}," "]
[{"$nulls":13}," "]
[{"$nulls":29},"U.S. Dollar Value:"]
[null,null,"Invoice/CR Number",{"$nulls":10}," "]
[null,null,"Reference (example: contact name,",{"$nulls":10}," "]
[null,null,"reason for payment)",{"$nulls":26},"Spot Date: "]
[]
[]
[{"$nulls":4},"Please write the PTAEO Distribution on the attached Invoice or Check Request",{"$nulls":24},"Bank Fees:"]
[]
[null,null,"Preparer:",null,null," ",{"$nulls":23},"Phone:"," "]
[null,null,"Requesting Department:",{"$nulls":7}," "]
[null,null,"Authorized By:",{"$nulls":6}," ",{"$nulls":19},"Phone:"," "]
[null,null,"Authorizer's Signature: ",{"$nulls":26},"Date:"," "]
[]
[null,null,"Submit form and all supporting documents (Invoice or Check Request) to the Accounts Payable Office. "]
[null,null,"Via campus mail or courier:  Accounts Payable/Yale Shared Services, 344 Winchester"]
[{"$nulls":14},"  Via email:    wires@yale.edu"]
[null,null,"Subject line format for email:  [Dept prefix] - [Vendor Name] - [Invoice/CR #]    e.g., LIBBEI-Johnson Books-Inv 13579"]
[null,null,"Accounts Payable and Treasury Use Only"]
[null,null,"Accounts Payable Approval / Use ",{"$nulls":11},"Controller's Office Approval ",{"$nulls":11},"Treasury Released By:"]
[]
[]
[null,null,"Date:",{"$nulls":11},"Date:",{"$nulls":11},"Date:"]
[]
[null,null,"Outside the US:         Yes           No"]
[null,null,"Exempt Code: "]