EFTA01580348.pdf

99969000-M0S-Wdr asetio uealooldr iIq paisanbael tuatuteau leituaPIJunD MOM TX3CINI AIS01099[ 010 tio [a5ed00:601l£P3Z/ZKOVIVEig IN1kJ1 1 -an Funds Transfer Request Meese Type instructions) Effective Date: 03112113 Please enter current a Mule date onty Select Appropiate Payment Type and Fields will be Displayed O JPMC Transfer O ACH O Check 0 Domestic Wire O International Wire Principal: $8.468.25 Income: ..• Debit Account Title: Southern Trust Company, Inc. Debit Account Address 1: Receiving Bank ABA: Citibank Address 2: Receiving Bank Name: Beneficiary Account #: David Tarlow & Co. CPA, PC City: Beneficiary Name: State: Zip Code: Pay 'thrbugh/Intounediary Party (II Requtrod) Account Type: O DDA (US) O Swift O Other IntermIdiary Bank Account/Code: Intermediary Bank Name: Payment Details (Reference/ Advice Description/Addenda) Invoices: 1000005013 & 1000005082 03/12/13 Date EFTA01580348