D.pdf
PDF 114 KB Posted
- Solicitation number
- IO459132
- Issued by
-
Department of Energy Office of Science
About this file
This is a vendor ACH Authorization Form used by Brookhaven National Laboratory/Brookhaven Science Associates (BNL/BSA) to set up direct deposit payments for vendors. The form requires vendors to provide their company information including name/DBA, vendor number, and Tax ID Number (TIN), along with banking details including financial institution name, routing/ABA number, and checking account number.
The form is related to a Department of Energy Office of Science solicitation (IO459132) for construction materials, coils, electrical supplies, and compressors. The RFQ seeks quotes for 54 various items with specific part numbers and quantities as detailed in Attachment A (draft Purchase Order). Vendors must submit pricing using Attachment C (Quotation Pricing Sheet) or the draft PO, with no substitutions accepted for the requested parts.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| A. Draft PO.PDF | ||
| B. AMS 50 Reps and Certs.pdf | ||
| C. Quation Pricing Sheet - fill in.pdf | ||
| E. W-9 Form.pdf | ||
| RFQ No 459132.pdf | ||
| A. Draft PO.PDF | ||
| F. W8 Form.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .