ࡱ> Z\Y%` H2bjbj"x"x .L@@ 84 j"{5T!!!!!!!$ #h%j!9{{!$"AAAd!A!AAA e~$XAqT:"0j"A%E%A%A0A!!Xj"          STATE OF MONTANA STATEWIDE ACCOUNTING SYSTEM ELECTRONIC FUNDS TRANSFER (International Wire Transfer)(Please deliver or fax to Treasury Unit)Business Unit # (5 chars): FORMTEXT      A/R Document #: FORMTEXT      Wire Amt: FORMTEXT      Plus Wire Fee: FORMTEXT      Equals SABHRS Total: FORMTEXT  =SUM(WireAmt,WireFee) 00.00Justification for using a Wire rather than ACH: FORMTEXT      1099 Reporting: FORMCHECKBOX  This payment doesn t require 1099 reporting. FORMCHECKBOX  This payment requires 1099 reporting; a W-9 form is on file for this vendor and requesting agency will enter the information into the 1099 system.Authorized Signature (agency):Date:Printed Name: FORMTEXT      Phone #: FORMTEXT      Check one transfer type below: FORMCHECKBOX  Repeat Code FORMTEXT       FORMCHECKBOX  Free Form (complete all fields below)Instructions for International Wire TransferAmount (US $ only): FORMTEXT      Date to b"Z\ B T X Z n p r | ~   & ( < > @ J L x z ŬŧŬŬŬ}hu~mHnHuj{hu~Ujhu~Ujhu~U hu~>*jhu~UmHnHujhu~Ujhu~U hu~6] hu~6CJhu~5B*CJphhu~ hu~6 hu~5CJhu~5>*CJ-"Z\ |hkd$$Ifl40Bn(, @(4 laf4p $$Ifa$$If$If$If 2F2 " X nOkdw$$Ifl40 n(y  a(4 laf4$If:kd$$Ifl4n(( (4 laf4   & N \ x $IfOkdv$$Ifl40_n("(4 laf4  , 4 8 : N P R \ ^   " $ & ~  $bdfߴߩߞߓߌ߁j[ hu~U hu~6>*j hu~Uji hu~Ujhu~Ujhu~Ujhu~UmHnHujhu~U hu~6]hu~hu~mHnHujhu~Ujhu~U1 6 8 c]#9kd$$Ifln(((4 la$Ifkd$$Ifl4ֈ- n({WV(4 laf48 ` b   IC$IfOkdD$$Ifl40n(V"(4 laf4 K0$If^`0  !$If<kdo$$Ifl40n(((4 laf4  !X $If R T $IfOkd5$$Ifl440n(V"(4 laf4 K$If "$Ifukd$$Ifl4\ J-"n() A(4 laf4"$bd<I9kd $$Iflmn(((4 la$IfukdQ $$Ifl4\3K)n(E (4 laf4<B,,(,*,,,.,B,D,F,P,R,,,,,,,,,,,־ְַ֥Η֕־օΗzΗjhu~Ujhu~U hu~]Ujhu~UmHnHujhu~U hu~6] hu~5\ hu~6jE hu~Ujhu~Uhu~jhjqUmHnHuj hu~UhjqjhjqU/<>@BYS$If9kdR $$Ifln(((4 la$Ifekd $$Ifl4Fn( (    4 laf4ytT@,,T,V,,,Lrkd$$Ifl\V4t"n(@ (4 la$If9kd $$Ifln(((4 lae Wired (mm/dd/yyyy): FORMTEXT      Recipient Bank Name: FORMTEXT      Recipient Bank City/Country: FORMTEXT      Check one recipient bank code type below: FORMCHECKBOX  SWIFT Code FORMTEXT       FORMCHECKBOX  Sort Code FORMTEXT      Beneficiary Account #: FORMTEXT      Beneficiary Account Name: FORMTEXT      Beneficiary Street Address: FORMTEXT      Beneficiary City/Country: FORMTEXT      OBI (Originator to Beneficiary Information to be Included - 140 char limit): FORMTEXT      To Be Completed by Treasury UnitTreasury Approval: FORMCHECKBOX  Approved FORMCHECKBOX  Not ApprovedReason: FORMTEXT       FORMCHECKBOX  Agency NotifiedAuthorized Signature:Date:     REVISED 10/2008 ,,, --b-_Lkd0$$Ifl0& n( H(4 la$IfLkdC$$Ifl0n(N (4 la,,,- --b-d-f----------------......&.(.*.Z.\.p.r.t.~.......ڽڲڭ|qjlhu~Ujhu~Ujhu~6UmHnHujRhu~6Ujhu~6U hu~6jhu~Ujthu~Ujhu~U hu~6>*hu~jhu~UmHnHujhu~Ujhu~U,b-d---.*.,.Z..Fukd$$Ifl4\K8n(A6(4 laf4$If<kd$$Ifl4mn(((4 laf4...../B/TLkd$$Ifl07 n( 7(4 la$If  !$IfLkd$$Ifl0n(}] (4 la...//0/2/4/>/@/x/z//////080:0>0@0T0V0X0b0d0h000000001 1 11*1,1.1Z1\1p1r1t1~111111氫j hu~Ujhu~U hu~5jhu~U hu~\hu~>*CJOJQJjphu~U hu~] hu~6j.hu~UjMhu~Uhu~jhu~Ujhu~UmHnHu4B/D/x///<0_Lkd$$Ifl0n(f t(4 la$IfLkd$$Ifl0l n( (4 la<0>00000:<kdU$$Ifl4Pn(((4 laf4 $P$Ifa$<kd$$Ifl40n(((4 laf4$If9kd$$Ifln(((4 la001 1 1J1Z11 K$IfOkd*$$Ifl40n(`!(4 laf4 K0$If^`0  !$If11111122ujddd$If  !$If K$If  $If^ ukd$$Ifl4\ n( 3(4 laf411122 2 2222222"222@2B2D2F2H2 h 6CJ hu~6CJhJjhJUhjq hu~5hu~jhu~Uj0hu~U22 2222222 2"2caaaaaaaaakd$$Ifl4ֈJl`"n(" (4 laf4 "2B2D2F2H2,/R / =!8"#$% $$If!vh55,#v#v,:V l4 @(,55,4f4pa$$If!vh5(#v(:V l4(,5(/  4f4tDText1$$If!vh5y 5a#vy #va:V l4(,5y 5a/  / 4f4tD Text2{$$If!vh55"#v#v":V l4(,55"/ 4f4DWireAmt#,##0.00DHWireFee#,##0.00D*=SUM(WireAmt,WireFee)#,##0.00$$If!vh55{5W55V5#v#v{#vW#v#vV#v:V l4(,55{5W55V5/ / / 4f4_$$If!vh5(#v(:V l(,5(/ 4vDText20_$$If!vh5(#v(:V l40(5(/ 4f4tDeCheck5{$$If!vh5V5"#vV#v":V l4(,5V5"/ 4f4tDeCheck4{$$If!vh5V5"#vV#v":V l44(,5V5"/ 4f4$$If!vh5) 555A#v) #v#v#vA:V l4(,5) 555A/ / 4f4tD#Text6tDText7$$If!vh5555E #v#v#v#vE :V l4(,5555E / / 4f4Q$$If!vh5(#v(:V lm(,5(4tDeCheck2vDText15tDeCheck3$$If!vh55 5#v#v #v:V l4(,55 5/ 4f4ytT@_$$If!vh5(#v(:V l(,5(/ 4_$$If!vh5(#v(:V l(,5(/ 4DText8#,##0.00D Text9M/d/yyyy$$If!vh555@ 5#v#v#v@ #v:V l(,555@ 5/ / 4vD8Text11u$$If!vh5N5 #vN#v :V l(,5N5 / 4vD4Text13u$$If!vh5 5H#v #vH:V l(,5 5H/ 4W$$If!vh5(#v(:V l4m(,5(4f4tDeCheck2jDtDeCheck3vDText22$$If!vh55A556#v#vA#v#v6:V l4(,55A556/ / 4f4vD7Text16u$$If!vh5}5] #v}#v] :V l(,5}5] / 4jD5u$$If!vh5 57#v #v7:V l(,5 57/ 4jD5u$$If!vh5 5#v #v:V l(,5 5/ 4jD6u$$If!vh5f 5t#vf #vt:V l(,5f 5t/ 4_$$If!vh5(#v(:V l(,5(/ 4vDText14m$$If!vh5(#v(:V l40(5(/ / 4f4_$$If!vh5(#v(:V l4P(5(/ 4f4tDeCheck5l$$If!vh55!#v#v!:V l4(+55!4f4tDeCheck4vD(Text21$$If!vh55535#v#v#v3#v:V l4(+,55535/ 4f4tDeCheck4$$If!vh555"5 55#v#v#v"#v #v#v:V l4(,555"5 55/ / 4f48@8 Normal_HmH sH tH 8@8 Heading 1$@&>*J@J Heading 2$$@&a$5CJOJQJD@D Heading 3$$@&a$ 5B*CJJ@J Heading 4$$@&a$5CJOJQJ8@8 Heading 5$@&5DAD Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List 0>@0 Title$a$CJ2B@2 Body Textx<P@< Body Text 2$a$CJ4@"4 Header  !4 @24 Footer  !$ L-.Hfg '.<jk12Qe*+@TUr-AB\pq34UVi   !"%000 00 0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0@0 @0 @0@0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 `0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 0X00X00X00X00X00X00X00X00@0X00X00D   ,.1H2 # 8  "<,b-.B/<0012"2H2  !"$%F2 %<G_ach 2BQ]ceu"(@LRr~ -9?\hn+1iy$FtFtFtFtF"ttFG$G$FFG$FG$FFFtFtG$F4G$F4FtFTFtFtFG$G$FG$8@0(  B S  ?Text1Text2WireAmtWireFeeText20Check5Check4Text6Text7Check2Text15Check3Text8Text9Text11Text13Text22Text16Text14Text213QfAs. % &Cdv)S@2%    "%   "%GGIVff&<iABQdtu)@Sr-@\o  2TTUUVVghxy    %   "% Jjqu~UT@.fg'<jk12Qe*+@TUr-AB\pq34UVi  "%@ 4$ ,UnknownGz Times New Roman5Symbol3& z Arial"1hMʆMʆJgF   9Y4d2QHX ?jq* ELECTRONIC Mark Curtis Mark CurtisOh+'0  0 < H T`hpx ELECTRONIC Mark CurtisEFT_Intl.dot Mark Curtis1Microsoft Office Word@@V8i'@|[$@|[$ ՜.+,0 hp  State of Montana '  ELECTRONIC Title  !"#$%&()*+,-./012345789:;<=>?@ABCDEFGHJKLMNOPRSTUVWX[Root Entry Fq~$]Data '1Table6%WordDocument.LSummaryInformation(IDocumentSummaryInformation8QCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q