Enclosure C - ACH Authorization Form.pdf

This document is an Automated Clearing House (ACH) Authorization Form for vendor payments from Brookhaven Science Associates, LLC (BSA), the operator of Brookhaven National Laboratory under contract with the U.S. Department of Energy. The form collects vendor information, including company name, tax ID, and financial institution details for setting up electronic fund transfers. It authorizes BSA to initiate ACH credit entries to the vendor's specified checking account. The form requires an authorized representative's signature and contact information.

The related federal contract opportunity is a Request for Quote (RFQ) for Commissioning Agent Services to be used for the Electron-Ion Collider (EIC) project at Brookhaven National Laboratory. The RFQ is set aside for Minority and Women-Owned Business Enterprises (MWBE), and requires vendors to certify that they meet the MWBE criteria defined by the state of New York. Any questions about the RFQ must be submitted by email to the specified point of contact by the stated deadline. The Department of Energy Office of Science is the federal agency issuing this contract opportunity.