Form TD-F 93.06 TD-F 93.06 Check Transaction Form

Check - Edit Transaction form
Institution: I-Select-

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Was this transaction
blocked offshore?:

Action Taken:

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Date Blocked/Rejected: i
( .... /OD/YVYV) L - -

Select Programs: rr=============;:;.=11

Bank Ref #:
I-Select-

Selected Programs:

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BALKANS
BELARUS
BLK-SDNTK

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$

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Check Number:

(Drawee Bank)

Date:

(.... / D D / Y V Y V ) "
PAY TO THE
ORDER OF .'--

Amount:

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Routing Number

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(USD ONLY)

Account Number

Originator

Was the above amount converted from another currency?

Attach Payment !·----------1,'[--=,-------,
Instructions:
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VALID FILE FORMATS FOR ATTACHMENTS: .PNG, .JPG, .GIF, .BMP, .TIF, .DOC, .RTF, .PDF DR .TXT
f.1AXIMUM FILE SIZ.E ACCEPTED IS 16MB

Additional Notes: !

1_--

Wednesday. Jan 20. 2010 09:39 AM

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