ACH Vendor Enrollment Form 2022.pdf

PDF 107 KB Posted

Attached to
Mattress Covers
Solicitation number
CT2369-25
Issued by

About this file

This is an ACH Vendor/Miscellaneous Payment Enrollment Form for UNICOR, Federal Prison Industries, Inc., used to collect vendor information for electronic payment processing.

The form captures comprehensive vendor details including company information, physical address, contact details, and business classification data such as large/small business status and various socioeconomic categories (disadvantaged, woman-owned, service-disabled veteran-owned). Financial information required includes DUN & Bradstreet number, Tax Identification Number (TIN), banking details with nine-digit routing transit number, depositor account information, and financial institution name. The form addresses shipping preferences, with UNICOR preferring FOB Destination terms where freight is included in the price to facilitate accurate and timely payments. Additionally, vendors must indicate whether they are registered and current in the System for Award Management (SAM), which is a mandatory federal-wide requirement for most vendors (excluding credit card vendors), with annual profile updates required when prompted via email at https://www.sam.gov.

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Text version

Company:

Physical Address:

City: State: Zip:

Contact:

Email Address:

Telephone: Fax:

Large: Small:

Disadvantaged: Woman Owned:

Service Disabled: Veteran Owned:

Yes: No:

DUN & Bradstreet #:

TAX Identification # (TIN):

Nine Digit Routing Transit Number:

Depositor Account Title:

Depositor Account Number:

Financial Institution Name:

Yes: No:

Our preference is always FOB Destination (freight included in price)*

*FOB DST helps with accurate and timely payment as well*

Does UNICOR Pay Shipping?

ACH Vendor/Miscellaneous Payment Enrollment Form UNICOR, Federal Prison Industries, Inc.

Company:

(please check one)

Registered And Current In System For Award Management - This is a Federal wide mandatory reuiqrement that is free to enroll (not required for credit card vendors)

Once enrolled you will have to anually update your profile when prompted via email.

https://www.sam.gov https://www.sam.gov/

Sheet1

Company:
Physical Address:
City:
State:
Zip:
Contact:
Email Address:
Telephone:
Fax:
DUN Bradstreet:
TAX Identification TIN:
Nine Digit Routing Transit Number:
Depositor Account Title:
Depositor Account Number:
Financial Institution Name:
Company-Small: Off
Company-Large: Off
Company-Disadvantaged: Off
Company-Womanowned: Off
SysAward-Yes: Off
SysAward-No: Off
Company-Disabled: Off
Company-Veteranowned: Off
UnicorPayShip-Yes: Off
UnicorPayShip-No: Off

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