B1 Enclosure D_ACH Authorization Form.pdf
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- Bluefors System Wires
- Solicitation number
- BSA467962
- Issued by
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Department of Energy Office of Science
About this file
This document is a Vendor ACH Authorization Form from Brookhaven National Laboratory, managed by Brookhaven Science Associates, LLC under contract with the U.S. Department of Energy. The form is designed for vendors to provide their banking information and authorize electronic payments through the Automated Clearing House (ACH) system. Vendors are required to complete sections for company details, including vendor/company name, vendor number, tax ID number, and banking information such as financial institution, routing/transit number, and checking account number. The authorization section allows the vendor to grant Brookhaven National Laboratory permission to initiate credit entries or make corrections to the specified bank account, with the understanding that this authorization remains in effect until written notification is received to terminate or modify it.
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Other files
| File | Type | Posted |
|---|---|---|
| B1 Enclosure F_W8 Form.pdf | ||
| B1 Enclosure B_AMS-FORM-050.pdf | ||
| B1 Enclosure E_W9 Form.pdf | ||
| B1 Enclosure C_AMS Form 043 Quotation Pricing Sheet.docx | DOCX document | |
| B1 Enclosure A Draft Contract 467962.pdf | ||
| B1 Solicitation 467962.pdf |
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Text version
Managed by Brookhaven Science Associates, LLC under contract with the
U.S. Department of Energy
Vendor ACH Authorization Form
VENDOR INFORMATION
Vendor/Company Name or DBA:
Vendor Number (if Applicable):
Tax ID Number (TIN):
DEPOSITORY INFORMATION
Financial Institution:
Routing/Transit/ABA Number:
Checking Account Number:
AUTHORIZATION
I (we) hereby authorize Brookhaven National Laboratory/Brookhaven Science Associates to make payments by initiating ACH (Automated Clearing House) credit entries or correcting entries to the account indicated above and associated with the financial institution named above. This authorization will remain in effect until BNL/BSA receives written notification to terminate or modify the same. It is my (our) understanding that credit authorizations may be revoked only by notification of the originator as described by NACHA (National Automated Clearing House Association) law.
Authorized Representative:
Email:
Phone:
Signature: Date:
| VendorCompany Name or DBA: |
| Vendor Number if Applicable: |
| Tax ID Number TIN: |
| Financial Institution: |
| RoutingTransitABA Number: |
| Checking Account Number: |
| Authorized Representative: |
| Email: |
| Phone: |
| Date: |
File details come from the government source that posted it. Updated .