5. Enclosure D - Vendor ACH Authorization Form.pdf
PDF 114 KB Posted
- Attached to
- Request for Quote 435797 for Installation of NSLS-II NEXT-II Beamline Shielding Enclosures
- Solicitation number
- 435797
- Issued by
-
Department of Energy Office of Science
About this file
This document contains a vendor ACH authorization form for Brookhaven National Laboratory/Brookhaven Science Associates. The form collects vendor information including company name, vendor number if applicable, tax ID number, financial institution details including routing number and checking account number. It authorizes BNL/BSA to make payments by initiating ACH credit or correcting entries to the specified account. The authorization remains in effect until written notification to terminate or modify is received.
The related federal contract opportunity is a request for quote issued by the Department of Energy Office of Science under solicitation number 435797. It seeks quotes for the installation of shielding enclosures at the NSLS-II NEXT-II beamline. Responses are due by the date specified in the solicitation. The award will be made to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 435797 Pre-Quote Presentation.pdf | ||
| 1. 435797 RFQ Letter Rev. 1.docx | DOCX document | |
| 2. Enclosure A - Draft Contract with attachments Rev. 1.pdf | ||
| 435797 Pre-Quote Meeting Questions and Answers.docx | DOCX document | |
| 4. Enclosure C - Quotation Pricing Sheet.docx | DOCX document | |
| 7. Enclosure F - W-8 Form.pdf | ||
| 1. 435797 RFQ Letter.docx | DOCX document | |
| 3. Enclosure B - AMS-FORM-050 - Annual Reps & Certs.pdf | ||
| 2. Enclosure A - Draft Contract with attachments.pdf | ||
| 6. Enclosure E - W-9 Form.pdf |
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Text version
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:
| VendorCompany Name or DBA: |
| Vendor Number if Applicable: |
| Tax ID Number TIN: |
| Financial Institution: |
| RoutingTransitABA Number: |
| Checking Account Number: |
| Authorized Representative: |
| Email: |
| Phone: |
| Date: |
File details come from the government source that posted it. Updated .