[NOOB question] Leadbolt Wire Transfer question

Hey,
I must payout from Leadbolt with Wire Transfer,
I am really NOOB and I write incorrect data in fields, They cancel my payment because of that
Can You guys help me with It??
I can't english pretty well and translate.google doesn't work well;(

I don't know what to write in these fields::
Account name
Send payment to

Can You tell me at an Example where I need to write what/?

EDIT:
If I don't correct it my Bank will send money back to Leadbolt and take 30$ for it....

You need to provide your bank name, account number, account name (your name registered with your bank), and Swift Code.