D - BankInformation.pdf
PDF 114 KB Posted
- Attached to
- Emerson Oil Fuel Meters
- Solicitation number
- IO457465
- Issued by
-
Department of Energy Office of Science
About this file
This is a vendor ACH (Automated Clearing House) authorization form used by Brookhaven National Laboratory/Brookhaven Science Associates (BNL/BSA) for processing electronic payments to vendors. The form requires vendors to provide their company information including company name, vendor number (if applicable), and Tax ID Number (TIN), along with banking details such as financial institution name, routing/ABA number, and checking account number.
The form is related to a solicitation (IO457465) for Emerson Oil Fuel Meters being procured by the Department of Energy Office of Science. The specific requirements are for 4 Micro Motion Elite Coriolis Meters (1 inch, DN25, 316L stainless steel, model CMF100M328N2BAEZZZ) for Boiler 7 Light Oil and 4 Micro Motion 4700 Field Mount Transmitters (model 4700R12ABAAAZZZAZ).
View the file
Other files
| File | Type | Posted |
|---|---|---|
| F - W8 Form.pdf | ||
| A - Draft Purchase Order.pdf | ||
| B - AMS 50 Reps and Certs.pdf | ||
| E - W9 form.pdf | ||
| C- AMS 43 Quation Prising Sheet.pdf | ||
| Request for Quote 457465.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 .