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Banking Forms

The banking forms below can be viewed with Adobe Reader.  Once Adobe Reader has been installed on your computer, begin entering the required information in the highlighted fields of the form. 

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Deposit Ticket Order Form

Instructions
  • You may only use this form if you make deposits into one of the following banks:  Bank of America, BB&T, First Citizens, PNC, SunTrust, or Wells Fargo.
  • Complete all of the fields on the form.
  • Review the information for accuracy and then submit the form.
  • Once submitted, a confirmation email will be sent to the email address provided on the form.​
Form Description ​
Deposit Ticket Order Form​​
Deposit Ticket Order Form with Online Submission Instructions


Core Banking (CB$) Template Forms 

Instructions
  • While viewing the form in Adobe Reader, tab through the form and enter the required information in the highlighted fields.
  • All forms require a signature so be sure to print and sign each form being used.
  • Scan the signed form and email it to the designated email address at the top of the form. 
  • If you have any questions on the templates, please call 919-814-3916
 Form Description ​
Account Transfer Template This form is used to setup a template on CB$ to tra​nsfer funds from one STIF/disbursing account to another. 
Federal Tax Payment Template This form is used to setup a template on CB$ and Wells Fargo to send a wire to the Wells Fargo account used for funding Federal Tax Withholding payments. 
International Wire Template This form is used to setup a template on CB$ and Wells Fargo to send a wire to the Wells Fargo account used for funding international wires. 
Investment Subscription Template This form is used to setup a template on CB$ to transfer funds from STIF/disbursing account to the NC Treasurer’s Long Term Investment Fund account. 
NCDOR Tax Payment Template This form is used to setup a template on CB$ to transfer funds from a STIF/disbursing account to the NC Department of Revenue’s account.​
Retirement Contribution Template This form is used to setup a template on CB$ to transfer funds from STIF/disbursing account to the account used for employee and employer contributions.​
Wire Transfer Template This form is used to setup a template on CB$ and Wells Fargo to send a wire to the beneficiary listed on the form.​



Wire Forms

Wire In Form with Online Submission Instructions

  • Follow the instructions on the Wire In Form and complete the required fields.
  • Submit the form online once completed.
  • Once submitted, a confirmation email will be sent to the email address provided on the form by the agency or university.  
 Form Description 
Wire In Form (with CMCS access) This online form is used by State agencies that have access to CMCS to deposit funds into their STIF accounts. 
Wire In Form (without CMCS access) This online form is used by State agencies that do not have access to CMCS to deposit funds into their STIF accounts. 

Wire Out Form with Instructions

  • While viewing the form in Adobe Reader, tab through the form and enter the required information in the highlighted fields.
  • All forms require a signature so be sure to print and sign each form being used.
  • Scan the signed form and any additional documentation required to process the request.
  • Email the completed form and documentation to the designated email address at the top of the form. 
 Form Description 
USD Wire Out Form This form is used by State agencies and financial institutions that do not have access to CB$ or have a template set up to wire funds from their STIF/disbursing accounts. 
International Wire Out Form This form is used by State agencies and universities to send international wires in US Dollars and foreign currencies. 

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Affidavits for State Warrants 

Instructions

  • While viewing the form in Adobe Reader, tab through the form and enter the required information in the highlighted fields.
  • All forms require a signature and notary so be sure to print and have each form being used notarized.
  • Mail the original notarized form to the designated mailing address at the top of the form. 
 Form Description ​
Affidavit for Altered State Warrant This affidavit is used by State entities when a paid warrant is determined to have been altered.
Affidavit and Indemnity Bond for an Individual (AIB) This affidavit is used by State entities when the payee of a warrant indicates that he/she has not benefited from the warrant made payable to him/her.
Affidavit and Indemnity Bond for Business (AIB) This affidavit is used by State entities when the payee of a warrant indicates the business has not benefited from the warrant made payable to the company.
Affidavit for Counterfeit State Warrant This affidavit is used by State entities when an item clears an agency account fraudulently, normally due to forged endorsement or altered payee.

Disbursing and STIF Account Forms
 

Instructions
  • While viewing the form in Adobe Reader, tab through the form and enter the required information in the highlighted fields.
  • All forms require a signature so be sure to print and sign each form being used.
  • Mail the original form to the designated mailing address at the top of the form. 
 Form Description ​
Application for New Disbursing or Short Term Investment Fund (STIF) Account This form is used by State entities applying for a new disbursing or STIF account.
Signature Card for Disbursing & STIF Account This form is used by State entities with all new Disbursing or STIF accounts or if authorized signers need to be amended.