ACH_FRM.pdf
PDF 20 KB Posted
- Attached to
- FLAME RESISTANT WOVEN CLOTH
- Solicitation number
- CT2269-19
About this file
This document contains an Automated Clearing House (ACH) Vendor/Miscellaneous Payment Enrollment Form and information on a related federal contract opportunity for Flame Resistant Woven Cloth.
The ACH form is used by UNICOR, Federal Prison Industries, Inc. to enroll vendors for electronic funds transfer payments through the ACH network. It collects company and financial institution details including name, addresses, taxpayer identification number, routing and account numbers. Upon completion, the form enables UNICOR to transmit payment data electronically to a vendor's bank.
The federal contract opportunity is a Request for Proposals issued by the Department of Justice Bureau of Prisons Federal Correctional Institution Manchester. It is soliciting proposals for a one year base contract plus four one-year options to provide Flame Resistant Woven Cloth. The requirement is unrestricted and utilizes firm-fixed pricing. Responses are due by the date specified in the solicitation, with award anticipated thereafter.
ACH FORM
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Other files
| File | Type | Posted |
|---|---|---|
| CT2269-19.pdf | ||
| Credit_Release_Authorization.pdf | ||
| businessmanagementquestionaire.doc | DOC document | |
| BERRY_AMENDMENT_CERTIFICATION.docx | DOCX document |
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Text version
UNICOR, Federal Prison Industries, Inc.
ACH Vendor/Miscellaneous Payment Enrollment Form
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor’s financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System. The TIN number submitted may be used for the purposes of collecting and reporting on any delinquent amounts arising out of such person’s relationship with the government.
AGENCY INFORMATION
FEDERAL PROGRAM AGENCY: UNICOR Federal Prison Industries, Inc.
AGENCY IDENTIFIER: UNICOR AGENCY LOCATION CODE (ALC): 15080001 ACH FORMAT: CTX
MAILING ADDRESS: UNICOR, Federal Prison Industries, Inc.
320 First Street N. W., Financial Management Branch, 8th Floor Washington, D.C. 20534
VENDOR PAYMENT CONTACT:
Tina Jeffery
E-MAIL:
Tina.Jeffery@usdoj.gov
TELEPHONE :
606-599-4151
FAX:
606-599-5115
PAYEE/COMPANY INFORMATION
**You must include your Dun & Bradstreet Number (DUNS #) **
COMPANY NAME: DUN & BRADSTREET NUMBER: CURRENT DATE:
COMPANY ADDRESS:
CONTACT PERSON:
TELEPHONE :
E-MAIL: FAX :
TAXPAYER IDENTIFICATION NO (TIN) OR SSN NO: ADDITIONAL INFORMATION:
FINANCIAL INSTITUTION INFORMATION
NAME:
ADDRESS:
ACH COORDINATOR NAME: TELEPHONE NUMBER:
NINE DIGIT ROUTING TRANSIT NUMBER:
DEPOSITOR ACCOUNT TITLE:
DEPOSITOR ACCOUNT NUMBER: LOCKBOX NUMBER:
TYPE OF ACCOUNT: ___ CHECKING ___ SAVINGS ___ LOCKBOX
(Check One) SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL:(could be the same as ACH Coordinator)
TELEPHONE :
File details come from the government source that posted it. Updated .