SEG and Subsidiary Outgoing Wire Form

Account Number
IBAN (for international
wires)

Beneficiary Name

Address (Line 1)
Address (Line 2)
City
State / Province

ZIP Code

Country

Bank Name
FED ABA or Routing
Number
OR
SWIFT

Company to Charge
US $ Amount
OR
Foreign currency - choose
from drop down

Amount

Memo for Beneficiary

Also fill out the appropriate wire request form for internal coding and approval. Submit both forms
along with the necessary documentation to accounting for processing.