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It includes fields for agency identification, type of request (add, delete, or change), payment details, and certification by authorized agency personnel. 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Also, I certify that I am authorized to transact business on behalf of  \nthe agency on the accounts listed above.  \nPhone Number:    \nSignature:   (Must be on signature card)  \nPrint Name:    \nPrint Title:    \n\n| NC Dept. of State Treasurer Use Only:\u003Cbr>Template \\# Assigned:   Signature Card Verified:  \u003Cbr>Completed by:   Approved by:  \u003Cbr>Original Template Opened Date:   | Template Setup/Modified on CB$:   Template Setup/Modified on Wells Fargo:  \u003Cbr>Date:  \u003Cbr>Date:  \u003Cbr>|\n| --- | --- |\n\nRevised 3/2020","cbCaibjfBLVLYxJ2","https://ap.wps.com/l/cbCaibjfBLVLYxJ2","pdf",50711,"English","# Request Information\n## Payment and Account Details\n## Certification and Authorization\n## Internal Processing Section","[{\"question\":\"What is the purpose of this form?\",\"answer\":\"The form is used to establish a template for repetitive wire transfers specifically for retirement contributions to the NC Department of State Treasurer.\"},{\"question\":\"What types of requests can be made using this form?\",\"answer\":\"Users can select to add a new template, delete an existing template, or change the details of an existing template.\"},{\"question\":\"What information is required to certify the request?\",\"answer\":\"The requester must provide their agency name, a valid CB$ Customer ID, phone number, signature, printed name, and job title to certify they are authorized to transact on behalf of the agency.\"}]","CB$ Template Form for Retirement Contributions | PDF",1790251763]