ach form - UEI.pdf
PDF 99 KB Posted
- Attached to
- Pallet Lumber
- Solicitation number
- FN1554-25
About this file
This is an ACH Vendor/Miscellaneous Payment Enrollment Form used by UNICOR Federal Prison Industries, Inc. for setting up automated clearing house payments through the Vendor Express Program. The form is designed to collect vendor payment information for electronic funds transfer.
The form requires comprehensive vendor details including company name, unique entity ID number (formerly DUNS), business size classification (large or small), taxpayer identification number, and complete banking information including routing number and account details. The form specifies that payments will be processed in CTX format through agency location code 15080001. The form includes sections for agency information, payee/company information, and financial institution information, with fields for contact details and authorized signatures. This document appears to be a standard payment enrollment form that vendors must complete to receive payments from UNICOR Federal Prison Industries.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Material for Factory and Target Quantity.pdf | ||
| A0001 FN1554-25 PALLET LUMBER.rtf | RTF text file | |
| FPI9999-Business Management Questionaire.pdf | ||
| 162000282-SOLICITATION.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:
UNIQUE ENTITY ID 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 :
Business Size ___ Large Business ____Small Business lkerr Cross-Out
File details come from the government source that posted it. Updated .