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.

The form authorizes Brookhaven National Laboratory/Brookhaven Science Associates to process payments to vendors via ACH (Automated Clearing House) credit entries or correcting entries. The form requires vendors to provide identification information including company name or DBA, vendor number if applicable, and Tax ID Number. Vendors must also supply depository information consisting of the financial institution name, routing/transit/ABA number, and checking account number. The authorization remains in effect until BNL/BSA receives written notification to terminate or modify it. The form requires an authorized representative's signature along with contact information including email and phone number. Revocation of credit authorizations is governed by NACHA (National Automated Clearing House Association) law and requires notification from the originator.