WIRE REQUESTS FORM

PLEASE REVIEW BEFORE SUBMITTING REQUEST

WIRE REQUESTS

International chapters/sections may request payment by electronic payment using the wire transfer form
or request a check using the check request form. All monies distributed will be in U.S. dollars.

All requests for wires must use the Wire Request Form. Any and all supporting documentation such as
a copy of an OSA grant award letter or start up fund documentation must be included.

OSA will make two attempts to send the funds. If the second attempt fails, the funds will be sent in
check form in U.S. dollars.

Non-U.S.-based chapters/sections must also complete the OSA International Student Chapter Funding
Receipt Form when requesting funds. This form identifies officer/s of the chapter that are authorized to
receive the funds on behalf of the chapter/section.

SUBMITTING THE FORM

Once you have completed the form you can e-mail it directly to OSA at chaptersandsections@osa.org.
You may also submit your request via mail to:
OSA Member Services
c/o Chapters and Sections
2010 Massachusetts Avenue, NW
Washington, DC 20036
If you submit your request via mail please provide a self-addressed return envelope for use in mailing your
check to the chapter.

Wire Request Form for International Student Chapters and Sections

Finance Only

1. Date Requested _____________________

2. Date Needed

Domestic
International

_____________________

3. Amount of Wire _____________________

________________
________________

_______________________________
Wire Approval (Executive Director or COO)

Please Provide Complete Address to Payee Bank & Individuals Account Information
Payable Through US Bank For International Wires
4. Wire Payable To:
Bank Name:
Branch:
Street Address, City, Zip:
Country:
Bank Account Number/IBAN
Name of Account Holder
Bank Swift number

________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________

Payable Through US Bank

________________________________________________
Branch
________________________________________________
Street Address, City, State, Zipcode
_________________________________________
Bank Routing Number (ABA or SWIFT) _________________________________________
Bank Account Number (May not be necessary) ____________________________________
5. Address:

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

6. Reference:

7. Purpose: (Deposit, Travel Advance, Refund, etc.) _________________________________

_____________________________________________________________________________
_____________________________________________________________________________
6. Special Instructions: (If any) _________________________________________________
__________________________________________________________________________
_________Area below this line will be completed by OSA staff._________
9. Is item in Budget?

YES

NO

If NO, Please explain _______________________________________________________________

_________________________________________________________________________________
10. Requested By: ___________________________

Date____/____/____

11. Approved By:

Date____/____/____

__________________________

12. Code # __ __ __ __- __ -__ __ __ - __ - __

Amount $ __________

Code # __ __ __ __ - __ __ - __ __ __ - __ __ - _0_

Amount $ __________

Code # __ __ __ __ - __ __ - __ __ __ - __ __ - _0_

Amount $ __________

Wire Request Form Instructions

1.
2.
3.
4.

Date Requested: The date you are filling out the form.
Date Needed: Note: It will take about 1-2 weeks to process wire transfers.
Amount of Wire: Fill in the total amount being requested.
Wire Payable To: This section must be completed in its entirety in order for your wire to be process.
It is especially important that the name of the recipient matches the name on the account to
which the funds will be wired.
It is recommended that your bank review this information for accuracy before submitting your
request.
5. Address: Provide the complete chapter address associated with the bank account receiving the wire
transfer
6. Reference: Create a reference phrase your bank can use when noting the transfer in your account. An
example would be OSA Grant Award.
7. Purpose: A brief explanation of what the funds are for. For example: Activity Grant 2006 or
Section Start-Up Funds.
8. Special Instructions: Wire transfers are made in U.S. dollars. If that is not possible, provide special
instructions in this area to request that funds be transferred in the currency of the receiving country.
9. Is Item in Budget?: This area will be completed by OSA staff.
10. Requested by: This area will be completed by OSA staff.
11. Approved by: This area will be completed by OSA staff.
12. Code #: This area will be completed by OSA staff.

Before you submit your non-U.S. wire request

Please verify that ALL information is accurate. It is especially important that the name of the recipient
matches the name on the account to which the funds will be wired.

Please be certain that all account numbers are correct.

Please note that OSA will make two attempts to send the funds. If the second attempt fails, the funds
will be sent in check form in U.S. dollars.