Delete Wire Transfer Request - Verification   Print this page
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Debit Information
  
Template name: One Time Transfer
Wire type: Domestic wire
Account: *2470 - PRESTIGE HEALTH ACCOUNT - Current $170,000.00
(Balances as of: (ET) Not a guarantee of available funds.)
Security code:  
Effective date:
Amount: $4,00.00
Currency: USD
Saved/returned by: ADMIN
Entry date/time: 02:06:28 PM (ET)
 
Recipient Information
Bank ID type: ABA
Bank ID: 123456789
Recipient account: (If appropriate enter the IBAN) 342780902
Bank name: New York State Bank
Bank address 1: Grand Rapids
Bank address 2:
MI
Bank address 3:
Recipient name: My Insurance Company
Recipient address 1: 12345 W.Side
Recipient address 2: Grand Rapids, MI
Recipient address 3:
Additional information for recipient: Policy BLA3874568ADKTYOE5886566
 
First Intermediary Information
Bank ID type:
Bank routing number:
Intermediary account: (If appropriate enter the IBAN)
Bank name:
Bank address 1:
Bank address 2:
Bank address 3:
 
Second Intermediary Information
Bank ID type:
Financial organization routing number:
Intermediary account: (If appropriate enter the IBAN)
Bank name:
Bank address 1:
Bank address 2:
Bank address 3:
 
Wire Initiator Information
Wire initiator name: PRESTIGE DESIGN CORPORATION
Wire initiator address 1: 5430 Data Court
Wire initiator address 2: Suite 100
Wire initiator address 3: Ann Arbor, MI