UNICORACH.pdf
PDF 84 KB Posted
- Attached to
- Various Cord and Drawstring
- Solicitation number
- CT2382-26
About this file
This is an ACH Vendor/Miscellaneous Payment Enrollment Form used by UNICOR, Federal Prison Industries, Inc., to process automated electronic payments to vendors through the Vendor Express Program. The form serves as a template for vendors to provide banking and financial institution information necessary for receiving ACH payments from UNICOR.
The form requires vendors to submit company information including their Dun & Bradstreet Number (DUNS #), Taxpayer Identification Number (TIN) or Social Security Number, and complete contact details. Vendors must also provide financial institution information, including the financial institution's name and address, nine-digit routing transit number, depositor account title and number, and account type (checking, savings, or lockbox). The form requires signature authorization from an authorized official of the financial institution. UNICOR's mailing address is PO Box 11849, Lexington, KY 40578-1849, and the vendor payment contact is Carla Coleman, reachable at 800-827-3168 ext. 3308 or Carla.Coleman@usdoj.gov. The agency uses CTX ACH format for payment processing. Submission of this form is required under 31 U.S.C. 3322 and 31 CFR 210, with information used by the Treasury Department to transmit payment data electronically to vendors' financial institutions.
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Other files
| File | Type | Posted |
|---|---|---|
| CT2382-26 Solicitation Questions -Cord.pdf | ||
| Credit Release Authorization.pdf | ||
| 1449.pdf | ||
| Business_Mgmt_Quest_.pdf |
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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.
PO Box 11849 Lexington, KY 40578-1849
VENDOR PAYMENT CONTACT:
Carla Coleman
E-MAIL:
Carla.Coleman@usdoj.gov
TELEPHONE :
800-827-3168, x3308
FAX:
859-253-8877
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 .