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AP-S Special Project Request Form
Form 3 : AP-S Special Project Request Form
Has a Final Report been submitted to the AP-S Chapter Activities Committee Chair?
Yes
No
Chapter Name, Chapter Classification (“AP-S Only” or “Joint”):
Chapter Name:
If “Joint” list partnering societies:
Requested Amount:
Other Sources of Support (list amount and organization):-
Amount
Organization
Section Support
Industrial
Other
Briefly describe the intended use of the funds:
Briefly describe how these funds will benefit the AP-S members:
Fund Transfer Information
Funding Method (checks one and fills out corresponding information):
Wire Transfer
ACH Transfer
Concentration Banking Transfer
Wire Transfer
Bank Account name (please be exact):
Bank Name:
Bank Address:
SWIFT Code:
Bank Account #
IBAN # (if applicable)
Special Instructions (include intermediary banks if applicable):
ACH Transfer
Bank Account name (please be exact):
Bank Name:
Bank Address:
ABA #
Bank Account #
Special Instructions (if applicable):
Concentration Banking Transfer
Concentration Banking Account Name:
Account Number (also known as HOP number):
Form Submit By
Submit
