Wire Transfers

Wire transfers to PIH often arrive with no accompanying donor information. In order for us to identify your gift and issue a tax receipt, please provide us with the following information.

Transfer instructions will be emailed to you upon submission of this form.

Country

First Name

Last Name

Address for Acknowledgment Letter*

Address for Acknowledgment Letter*
	Address for Acknowledgment Letter*	Item weight

more items

City

State/Region/Province*

Zip/Postal Code

Phone

Name on Initiating Account

Originating Bank

Gift Value (in USD)

Gift Transfer Date

Transfer instructions will be emailed to you upon submission of this form.

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.