Wire Transfer Refund

Form

All information requested is mandatory. Delays may occur if any pertinent information is missing. (Please print)

Date of Transfer: (mm/dd/yyyy)

Total Amount : $

Payee Information

Student Name :

UWINDSOR ID# (9-digits) :

For request to be completed, student must provide detailed reason for request in space below
Purpose of Wire / Message to Payee:

I authorize the University of Windsor to initiate a refund of the above amount paid to my account
through CIBC ISP (International Student Pay) to the original sender.
Student Name:
(print)
Signature : Date : (mm/dd/yyyy)

For internal use only

Approved by :
(print)
Signature : Date : (mm/dd/yyyy)