B.1 Enclosure D Vendor ACH.pdf

This is a Vendor ACH Authorization Form for Brookhaven National Laboratory, managed by Brookhaven Science Associates, LLC under contract with the U.S. Department of Energy.

The form is a template designed to authorize ACH (Automated Clearing House) payments to vendor accounts. It requires vendors to provide standard identification information including company name or DBA, vendor number if applicable, and Tax ID Number. The depository information section requires the financial institution name, routing/transit/ABA number, and checking account number where payments should be directed. The authorization section grants BNL/BSA permission to initiate ACH credit entries and correcting entries to the designated account. The authorization remains in effect until BNL/BSA receives written notification to terminate or modify it, and vendors understand that credit authorizations may be revoked only by notification of the originator in accordance with NACHA (National Automated Clearing House Association) law. The form must be signed by an authorized representative who provides their name, email address, phone number, signature, and date.