D. BankInformation.pdf

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

The form serves as a template for vendors to authorize BNL/BSA to process payments via Automated Clearing House (ACH) credit entries and correcting entries to the vendor's designated bank account. The form requires vendors to provide their company name or DBA, vendor number (if applicable), and Tax ID Number. In the Depository Information section, vendors must supply their financial institution name, routing/transit/ABA number, and checking account number. The authorization remains in effect until BNL/BSA receives written notification to terminate or modify it, with the understanding that credit authorizations may only be revoked in accordance with NACHA (National Automated Clearing House Association) law. The form requires signature from an authorized representative along with their printed name, email address, phone number, and date of authorization.