Enclosure D Vendor ACH Authorization Form.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 processing for vendors.

The form requires vendors to provide standard identification information including company name or DBA, vendor number (if applicable), and Tax ID Number. In the Depository Information section, vendors must supply their financial institution details including the routing/transit/ABA number and checking account number. By signing the authorization, vendors grant Brookhaven National Laboratory/Brookhaven Science Associates the right to initiate ACH (Automated Clearing House) credit entries and correcting entries to the specified account. The authorization remains in effect until written notification is received to terminate or modify it, with any revocation subject to NACHA (National Automated Clearing House Association) law requirements. The form requires signature, date, and contact information (name, email, and phone number) from an authorized representative of the vendor.