H9227723Q0005_EFT_Form_KAIIAB.pdf

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UFC FORM 26, SEP 2013

REPLACES UFC-DISB 7, UNDATED, WHICH IS OBSOLETE.

US Army Corps of Engineers Finance Center (UFC)

WIRE TRANSFER AUTHORIZATION FORM

The proponent agency is CEFC-FD.

See instructions on the reverse of this form.

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY 31 U.S.C 3322 and 31 CFR 210.

PRINCIPAL PURPOSE For personnel support.

ROUTINE USES This information will be used by the U.S. Army Corps of Engineers, hereinafter called USACE, to transmit data by electronic means to vendor’s financial institution.

DISCLOSURE I hereby authorize USACE to initiate direct deposit credit entries to my (our) account indicated below and the financial institution named below, hereinafter called DEPOSITORY, to credit the same to such account. Failure to provide the requested information may delay or prevent the receipt of payments.

SECTION I - COMPANY INFORMATION

SECTION II - FINANCIAL INSTITUTION

9. CONTRACT NUMBER (optional; if more than one contract, please list on a separate sheet)

SECTION III - CORRESPONDING BANK 1

SECTION IV - CORRESPONDING BANK 2

SECTION VI - INSTRUCTIONS

INSTRUCTIONS FOR COMPLETING UFC FORM 26, WIRE TRANSFER AUTHORIZATION

SECTION I - COMPANY INFORMATION:

1. Include the name or Company as it appears on the invoice. This should be the same as the name on the contract.

2. This address should be the physical address of the business.

3-6. The city, state, country and postal code should be for the physical address.

7. The mailing address should include any and all Remit to/payment addresses that are different from the physical address.

8. Include daytime phone number and/or e-mail address in case there are questions concerning the completed form.

SECTION II - FINANCIAL INSTITUTION:

10. The name of the bank for the person or company listed in block 1.

11. Bank address 12 -15. City, state, country, and postal code of the bank.

16. The SWIFT or Bank Identifier Code (BIC) of the bank.

17. The account number at this bank of the person or company listed in block 1.

18. Exact name on the above account at this bank. Bank will not credit the account if the recipient of the wire transfer is different than the name on the account.

SECTION III - CORRESPONDING BANK 1:

19. Name of corresponding bank. If this bank is not located in the United States, completion of Section IV, 29-38 is also required.

20. Address of corresponding bank.

21-24. City, state, country and postal code of corresponding bank.

25. SWIFT, Bank Identifier Code (BIC), or ABA number of corresponding bank.

26. Account number at corresponding bank of bank listed in Section II, block 10.

SECTION IV - CORRESPONDING BANK 2:

29. Additional corresponding bank if first corresponding bank is not located in the United States.

30. Address of this corresponding bank.

31-34. City, state, country, and postal code of this corresponding bank.

35. SWIFT, Bank Identifier Code (BIC) or ABA number of corresponding bank.

36. Account number at this corresponding bank of the bank listed in Section III, block 1.

Section IV, blocks 29 thru 38 will only be necessary if the first corresponding bank is not located in the United States.

UFC FORM 26, SEP 2013

SECTION V - AUTHENTICATION

9.0.0.2.20120627.2.874785