UNIVERSITY PHYSICIANS HEALTH PLANS

 

ELECTRONIC FUNDS TRANSFER

BANKING INFORMATION

 

 

Fax to:  (520) 874-3483

Attention: Carla Charlow, Accounts Payable

 

           

Vendor Name: ­­­­­­­­­­  ________________________________________________

 

Vendor Number Appearing on Remittance Advices:   ___________________

 

Vendor Contact Name:   ________________________________________

 

Vendor Contact Phone:   _________________________

 

Bank Account Name:  ____________________________________________

 

Bank Account Number: ___________________________________________

 

Wire Transfer ABA Routing Number: ________________________________

 

ACH ABA Routing Number: _______________________________________