Inbound Transfer Notification Form

Inbound Bank Transfer Notification Form

Submitter Information
Campus Contact*

First

Last
Campus/Department*
Email Address*
Phone Number*
Date

MM slash DD slash YYYY
Payer Information
Organization Name*
Contact Name*

First

Last
Contact Email Address*
Contact Phone Number*
Expected Payment Date*

MM slash DD slash YYYY
Expected Payment Amount*
Currency*
- US Dollars
- Other Currency
If other type of currency, please explain:
Payment Type*
- Wire
- ACH
USM Foundation Information
USM Foundation Number to Credit*
USMF Account Name to Credit*
Explanation of Payment*