6-ACH Enrollment Information - fillable.pdf

This is an ACH Enrollment Information form designed for vendors contracting with government agencies to establish electronic funds transfer (EFT) payment arrangements. The form requires submission of company financial and banking details necessary for automated clearinghouse (ACH) direct deposit of contract payments. Required information includes company name, address, Federal Identification Number (FIN), DUNS number, primary contact information (email, phone, fax), and complete financial institution details including bank name, account name, routing number, and EFT bank account number. The form is fillable and structured to capture payment remittance specifications, allowing vendors to designate a specific contact for directing payment communications. Multiple text fields are provided for additional documentation or notes related to the enrollment process.

This enrollment form serves as a prerequisite administrative document for vendors awarded state and local contracts. Submission of accurate ACH enrollment information is typically required before contract execution and initial payment processing. The form does not specify a particular jurisdiction but is applicable across various government contracting opportunities, including those administered by municipalities, counties, and state agencies. Vendors must ensure all banking information is accurate and current to facilitate timely payment processing, as incomplete or incorrect enrollment data may delay contract fund disbursement. The form may be submitted electronically through government e-procurement portals or directly to the contracting agency's finance department as specified in individual solicitation requirements.