Enclosure 4 - Vendor ACH Authorization Form.pdf
PDF 717 KB Posted
- Solicitation number
- CE446914
- Issued by
-
Department of Energy Office of Science
About this file
This document is a Vendor ACH Authorization Form that allows Brookhaven National Laboratory/Brookhaven Science Associates (BNL/BSA) to make payments to vendors via Automated Clearing House (ACH) credit entries. It requires the vendor to provide their banking information, including financial institution, routing/transit/ABA number, and checking account number. The authorized representative must sign and date the form to authorize this payment method.
The related federal contract opportunity is a Request for Quote (RFQ) for RFG Regular 87 Unleaded Fuel, managed by Brookhaven Science Associates (BSA) on behalf of the Department of Energy Office of Science. The RFQ outlines the fuel requirements and requests that vendors provide the origin of manufacture and their Unique Entity Identifier (UEI). Responses are due by 6/28/24. Any resulting Purchase Order will be subject to the attached terms and conditions.
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Other files
| File | Type | Posted |
|---|---|---|
| Questions_Answers CE446914.docx | DOCX document | |
| BSA_Commercial_Items_Rev22_Sep_2022.pdf | ||
| Enclosure 6 W-8 Form (Foreign vendors).pdf | ||
| Attachment B - BNL QA 101.pdf | ||
| RFQ Letter.docx | DOCX document | |
| Enclosure 3 - AMS Form 043.docx | DOCX document | |
| Attachment C - NYSEnvironConservation.pdf | ||
| Attachment A - Specification.pdf | ||
| Enclosure 1 - Draft Purchase Order.pdf | ||
| Enclosure 5 W-9 Form (Domestic vendors).pdf | ||
| Enclosure 2 - AMS Form 050.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:
Enclosure 4
File details come from the government source that posted it. Updated .