ACH Vendor Enrollment Form 2024.pdf

This is an ACH Vendor/Miscellaneous Payment Enrollment Form for UNICOR (Federal Prison Industries, Inc.).

The form is a vendor registration template requiring companies to provide standard business information including company name, physical address, contact details, telephone, and fax number. Vendors must identify their business classification by selecting Large or Small business status and indicating if they qualify as Disadvantaged, Woman-Owned, Service Disabled, or Veteran-Owned enterprises. The form requires collection of financial data including SAM UEI Number, Tax Identification Number (TIN), nine-digit routing transit number, depositor account title, account number, and financial institution name to establish ACH payment capabilities. A key requirement section addresses shipping preferences, with UNICOR's stated preference being FOB Destination with freight included in the quoted price to facilitate accurate and timely payment processing. The form mandates that vendors be registered and current in the System for Award Management (SAM) at https://www.sam.gov, noting this is a federal-wide mandatory requirement that is free to complete (though not required for credit card vendors). Vendors must maintain current SAM enrollment through annual profile updates when prompted by email. The form provides checkboxes for vendors to confirm Yes or No responses to SAM registration status and shipping payment arrangements.