Wire Transfer - Bankshop Investimentos

Customer Details

Name *

First

Last

Account Number *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Social Security Number

Wire Amount *

Date of Transfer *

Phone

Receiver's Payment Information

Name of Bank *

Bank Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Account No. *

Routing No. *

Account Type *

Checking
Savings

Payment Frequency *

Reference/Extra Notes

International Transfer

U.S. Corresponding Bank/ABA Number

International Bank Name

Swift Number

City

Country

Date