B.1 Enclosure D Vendor ACH.pdf

This is a Vendor ACH Authorization Form used by Brookhaven National Laboratory (managed by Brookhaven Science Associates, LLC under contract with the U.S. Department of Energy) to establish electronic payment capabilities for vendors.

The form requires vendors to provide identifying information including company name or DBA, vendor number if applicable, and Tax ID Number. Vendors must supply depository information consisting of the financial institution name, routing/transit/ABA number, and checking account number. By signing the authorization, vendors grant Brookhaven National Laboratory/Brookhaven Science Associates permission to initiate ACH (Automated Clearing House) credit entries or correcting entries to the designated account. The authorization remains active until BNL/BSA receives written notification to terminate or modify it, with any revocation subject to NACHA (National Automated Clearing House Association) law requirements. The form requires signature from an authorized representative along with contact information including email, phone number, and date of authorization.