Enclosure D - Vendor ACH Authorization Form.pdf

114 KB Posted

Attached to
Laser Welding Stainless Steel Assembly
Solicitation number
MB447773
Issued by

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This document is a Vendor ACH Authorization Form for Brookhaven National Laboratory/Brookhaven Science Associates. It authorizes the initiation of ACH credit entries or corrective entries to the vendor's specified checking account at their financial institution. The form includes the vendor's information such as name, tax ID, and contact details, as well as the depository information including the financial institution, routing/transit number, and account number. The authorized representative must sign and date the form to provide this ACH payment authorization.

The related federal contract opportunity is a solicitation from the Department of Energy Office of Science for Laser Welding Stainless Steel Assembly. The solicitation number is MB447773. The statement of work and drawings are attached, but no other details about the required products/services, response dates, award dates, pricing terms, or set asides are provided.

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Other files

File Type Posted
Attachment 1 - Statement of Work_447773_Rev 3.pdf PDF
Amendment No. 1 to RFQ 447773.pdf PDF
Attachment 2 - Drawing hsr-va-scn-0106.pdf PDF
Attachment 5 - Drawing hsr-va-scn-1004.pdf PDF
Enclosure F - W-8 Form (Foreign Vendors).pdf PDF
Attachment 4 - Drawing hsr-va-scn-0109.pdf PDF
Attachment 1 - Statement of Work_447773_Rev 2.pdf PDF
Enclosure E - W-9 Form.pdf PDF
Enclosure B - AMS-FORM-050 Annual Representations_Certifications.pdf PDF
B1. Request for Quote 447773.pdf PDF
Attachment 6 - Drawing hsr-va-scn-1150_RevC.pdf PDF
Attachment 3 - Drawing hsr-va-scn-0107.pdf PDF
Enclosure C - Quotation Pricing Sheet.pdf PDF
Enclosure A - Draft PO 447773.PDF PDF
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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:

VendorCompany Name or DBA:
Vendor Number if Applicable:
Tax ID Number TIN:
Financial Institution:
RoutingTransitABA Number:
Checking Account Number:
Authorized Representative:
Email:
Phone:
Date:

File details come from the government source that posted it. Updated .