Partners In Health

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

Email*

First Name*

Last Name*

Address for Acknowledgment Letter*

City*

State/Region/Province*

Zip/Postal Code*

Phone*

Name on Initiating Account*

Originating Bank

Gift Value (in USD)*

Gift Transfer Date

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