ANL-1094.pdf
PDF 41 KB Posted
- Attached to
- Kinova Gen3 7
- Solicitation number
- 4-B168-Q-00653-00
- Issued by
-
Department of Energy Office of Science
About this file
This document is an Electronic Transfer Authorization Form for Argonne National Laboratory. It authorizes Argonne to initiate credit and debit entries to the company's bank account and provides the financial institution information, including the routing number, account number, and account type (checking or savings). The form also includes the company's name, remittance address, contact information, and authorized signature.
The related federal contract opportunity is a Request for Proposal (RFP) for 2 Kinova Gen3 7 DoF ME-OT-357062 v7.2 robotic arms, 1 Universal Robots UR16e collaborative robot arm, and associated accessories. The RFP will be evaluated based on the lowest price, technically acceptable methodology. Proposals are due by 5:00 pm CST on August 4, 2024. The contracting agency is the Department of Energy Office of Science.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| ANL-70A Request for Quotation .doc | DOC document | |
| ANL-70B Reps and Certs.pdf | ||
| ANL-71 COM ARGONNE TERMS AND CONDITIONS.PDF |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Electronic Transfer Authorization Form
ANL-1094 (02/04/2020)
Vendor Number (For Internal Use Only)
I hereby authorize Argonne National Laboratory managed by UChicago Argonne, LLC (Argonne) to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to the company’s account indicated below and the Financial Institution named below. This authorization will remain in effect until Argonne Accounts Payable Section receives written notification to terminate the authorization. Please allow 30 days for processing changes.
New forms must be submitted for any changes and/or cancellations to any of the information indicated on this form.
Return completed form to one of the destinations below. If choosing email, please do not send over unsecure connections.
Secure email:
paymentforms@anl.gov
Secure Fax:
630-252-8270
Argonne National Laboratory Cashier 9700 South Cass Avenue, Bldg 201 Lemont, IL 60439
Financial Institution Information Financial Institution Name:
Institution Address:
Institution City / State / Zip / Country (req’d if Int’l):
Telephone # (if necessary):
You may only setup one bank account for Electronic Payments:
Checking OR Savings Cancel Checking Cancel Savings
Routing Number / ABA # (Must be 9 Digits) / SWIFT
BIC:
Account # / IBAN:
Authorization Information Company Name or DBA:
Remittance Address:
City / State / Zip: Telephone #:
E-mail Address (For Remittance Advise):
Printed Name: Title:
Authorized Signature: Date:
(For Internal Use Only:)
Entered by: Date:
Print Sign mpshields Highlight mpshields Highlight mpshields Highlight mpshields Highlight mpshields Highlight mpshields Highlight mpshields Highlight mpshields Highlight mpshields Highlight mpshields Highlight mpshields Highlight
| Financial Institution Name: |
| Institution Address: |
| Institution City State Zip Country reqd if Intl: |
| Telephone if necessary: |
| Checking: On |
| Cancel Checking: Off |
| Cancel Savings: Off |
| Company Name or DBA: name of the Individual |
| Remittance Address: |
| City State Zip: |
| Telephone: |
| Email Address For Remittance Advise: |
| Printed Name: |
| Title: |
| Authorized Signature: |
| Date: |
| Entered by: |
| Date_2: |
| Sign: |
| Savings: Off |
| Vendor Number: |
| Routing Number / ABA #: |
| Account # / IBAN: |
File details come from the government source that posted it. Updated .