AttachmentS_ACH Vendor Enrollment Form.pdf

This document is an ACH (Automated Clearing House) Vendor/Miscellaneous Payment Enrollment Form issued by the U.S. Department of Treasury. The form is designed for setting up electronic payment processing through the Vendor Express Program, with an OMB No. 1510-0056 and an expiration date of 06/30/93.

The form contains multiple sections for capturing detailed financial information, including spaces for Federal Program Agency details, Payee Company Information, and Financial Institution Information. It includes a Privacy Act Statement explaining that the information collected will be used by the Treasury Department to transmit payment data electronically to the vendor's financial institution. The form allows for specifying account type (checking or savings), routing transit number, depositor account details, and requires signatures of authorized officials to process the electronic payment enrollment.