D. Vendor ACH Athorization Form - For information only.pdf

This is a Vendor ACH Authorization Form used by Brookhaven National Laboratory (managed by Brookhaven Science Associates, LLC under contract with the U.S. Department of Energy) to establish electronic payment procedures with vendors.

The form requires vendors to provide three categories of information: vendor identification (company name/DBA, vendor number if applicable, and Tax ID Number), depository information (financial institution name, routing/transit/ABA number, and checking account number), and authorization credentials (authorized representative name, email, phone, signature, and date). By signing this form, vendors authorize Brookhaven National Laboratory/Brookhaven Science Associates to initiate ACH (Automated Clearing House) credit entries or correcting entries to the designated bank account. The authorization remains in effect until written notification is received to terminate or modify it, and vendors acknowledge that credit authorizations may be revoked only through notification to the originator in accordance with NACHA (National Automated Clearing House Association) law. This is a template form with no specific contract opportunities, products, services, or response dates identified.