ACH FORM.pdf
PDF 125 KB Posted
- Attached to
- RFP FN1615-26 UNICOR METALS
- Solicitation number
- FN1615-26
About this file
This is an ACH Vendor/Miscellaneous Payment Enrollment Form used by UNICOR, Federal Prison Industries, Inc. for processing electronic payments through the Automated Clearing House (ACH) system via the Vendor Express Program.
The form is a template designed to collect vendor banking and payment information required by 31 U.S.C. 3322 and 31 CFR 210. Vendors must complete sections including company information (with required Dun & Bradstreet Number), taxpayer identification number, financial institution details, and account type (checking, savings, or lockbox). The form requires designation of business size (large or small business), contact person information, and authorization by a company official. UNICOR's mailing address is listed as 320 First Street N.W., Financial Management Branch, 8th Floor, Washington, D.C. 20534, with Agency Identifier code 15080001 and ACH format CTX. The form emphasizes that failure to provide complete information may delay or prevent payment receipt, and notes that submitted TIN numbers may be used for collecting and reporting delinquent amounts owed to the government.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| METALS PRICING SPREADSHEET_A0001.xlsx | XLSX spreadsheet | |
| FN1615-26_A0001.pdf | ||
| METALS PRICING SPREADSHEET.xlsx | XLSX spreadsheet | |
| BUSINESS MANAGEMENT QUESTIONNAIRE.pdf | ||
| FN1615-26_1620000383.pdf |
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Text version
UNICOR, Federal Prison Industries, Inc.
ACH Vendor/Miscellaneous Payment Enrollment Form
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor=s financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System. The TIN number submitted may be used for the purposes of collecting and reporting on any delinquent amounts arising out of such person=s relationship with the government.
AGENCY INFORMATION
FEDERAL PROGRAM AGENCY: UNICOR Federal Prison Industries, Inc.
AGENCY IDENTIFIER: UNICOR AGENCY LOCATION CODE (ALC): 15080001 ACH FORMAT: CTX
MAILING ADDRESS: UNICOR, Federal Prison Industries, Inc.
320 First Street N. W., Financial Management Branch, 8th Floor Washington, D.C. 20534
VENDOR PAYMENT CONTACT: E-MAIL: TELEPHONE : FAX:
PAYEE/COMPANY INFORMATION
**You must include your Dun & Bradstreet Number (DUNS #) **
COMPANY NAME: NUMBER: CURRENT DATE:
COMPANY ADDRESS:
CONTACT PERSON: TELEPHONE : E-MAIL: FAX :
TAXPAYER IDENTIFICATION NO (TIN) OR SSN NO: ADDITIONAL INFORMATION:
FINANCIAL INSTITUTION INFORMATION
NAME:
ADDRESS:
ACH COORDINATOR NAME: TELEPHONE NUMBER:
NINE DIGIT ROUTING TRANSIT NUMBER:
DEPOSITOR ACCOUNT TITLE:
DEPOSITOR ACCOUNT NUMBER: LOCKBOX NUMBER:
TYPE OF ACCOUNT: ___ CHECKING ___ SAVINGS ___ LOCKBOX
(Check One) SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL:(could be the same as ACH Coordinator) TELEPHONE :
File details come from the government source that posted it. Updated .