Pmi Order 28000162695
Pmi Order 28000162695
Pmi Order 28000162695
No. 28000162695
Billing Address:
Salahadin Mohammed
Ethiopian Reinsuracne
Addis Ababa, 1000
Ethiopia
Please Note: For Security purposes, DO NOT send this form via email to PMI if paying by credit card. Send via secure fax to 610-819-0746
☐ Check ☐ ACH ☐ Wire Transfer Please Note: Wire fees are applicant's responsibility ☐ Purchase Order
☐ Mastercard ☐ Visa ☐ American Express ☐ Diners Club ☐ Discover ☐ JCB
Bank information for Domestic & International Wires: Bank information for ACH:
Wells Fargo Bank, N.A. Wells Fargo
420 Montgomery Street Account Number: 2014183097209
San Francisco, CA 94104 USA Routing Transit Number: 031000503
Account Number: 2014183097209
Routing Transit Number: 121000248
Swift Code: WFBIUS6S