Enclosure 4 - Vendor ACH Authorization Form.pdf

136 KB Posted

Attached to
Amendment No. 2 to Fuel Oil Burner Grade # 4 - CSF
Solicitation number
453320CE
Issued by

About this file

Written by GovTribe AI ·

This document is a Vendor ACH Authorization Form that allows Brookhaven National Laboratory/Brookhaven Science Associates to make payments to a vendor via Automated Clearing House (ACH) credit entries. The form requires the vendor to provide their company information, financial institution details, and authorization for BNL/BSA to initiate ACH transactions. This form is related to a federal contract opportunity for Fuel Oil Burner Grade # 4 - CSF, solicitation number 453320CE. The opportunity is managed by the Department of Energy Office of Science and requests quotes from vendors to provide the specified fuel oil. Vendors are required to provide the origin of manufacture and their Unique Entity Identifier (UEI) in their quote. The quote deadline is 12/3/24.

View the file

Other files

File Type Posted
Amendment No. 2 Questions_Answers_453320CE.pdf PDF
Questions_Answers 453320CE.pdf PDF
Attachment A - Specifications_Rev. 1_11_25_24.pdf PDF
BSA_Commercial_Items_Rev22_Sep_2022.pdf PDF
Enclosure 5 W-9 Form (Domestic vendors).pdf PDF
Enclosure 3 - AMS Form 043.docx DOCX document
Attachment A - Specifications.pdf PDF
RFQ Letter.pdf PDF
Enclosure 2 - AMS Form 050.pdf PDF
Enclosure 6 W-8 Form (Foreign vendors).pdf PDF
Enclosure 1 - Draft PO.pdf PDF
Show all 11

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Managed by Brookhaven Science Associates, LLC under contract with the

U.S. Department of Energy

Vendor ACH Authorization Form

VENDOR INFORMATION

Vendor/Company Name or DBA:

Vendor Number (if Applicable):

Tax ID Number (TIN):

DEPOSITORY INFORMATION

Financial Institution:

Routing/Transit/ABA Number:

Checking Account Number:

AUTHORIZATION

I (we) hereby authorize Brookhaven National Laboratory/Brookhaven Science Associates to make payments by initiating ACH (Automated Clearing House) credit entries or correcting entries to the account indicated above and associated with the financial institution named above. This authorization will remain in effect until BNL/BSA receives written notification to terminate or modify the same. It is my (our) understanding that credit authorizations may be revoked only by notification of the originator as described by NACHA (National Automated Clearing House Association) law.

Authorized Representative:

Email:

Phone:

Signature: Date:

Enclosure 4

File details come from the government source that posted it. Updated .