VendorACHForm.doc
DOC document 36 KB Posted
- Attached to
- Matchmaker Component Seating Parts Federal contract opportunity
- Solicitation number
- FN1348-12
- Issued by
- Department of Justice Bureau of Prisons
About this file
Vender ACH Form
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| A0004 FN1348-12 Matchmaker Component Seating Parts.rtf | RTF text file | |
| FN1348-12 EXCEL BASE OPTION YEAR PRICING SHEET Amended 01-06-12.xlsx | XLSX spreadsheet | |
| A0003 Matchmaker Amendment FN1348-12 dated 01-06-12.pdf | ||
| FN1348-12 EXCEL BASE OPTION YEAR PRICING SHEET.xlsx | XLSX spreadsheet | |
| Matchmaker Solicitation FN1348-12.pdf | ||
| Drawings for ASY3110R ASY32110L ASY3112C.pdf | ||
| A0001 FN1348-12 Matchmaker Component Seating Parts.rtf | RTF text file |
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Text version
UNICOR, Federal Prison Industries, Inc.
ACH Vendor/Miscellaneous Payment Enrollment Form This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor’s financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System. The TIN number submitted may be used for the purposes of collecting and reporting on any delinquent amounts arising out of such person’s relationship with the government.
AGENCY INFORMATION
FEDERAL PROGRAM AGENCY: UNICOR Federal Prison Industries, Inc.
| AGENCY IDENTIFIER: UNICOR |
| AGENCY LOCATION CODE (ALC): |
| ACH FORMAT: CTX |
UNICOR, Federal Prison Industries, Inc.
PAYEE/COMPANY INFORMATION
**You must include your Dun & Bradstreet Number (DUNS #) **
| COMPANY NAME: |
| DUN & BRADSTREET NUMBER: |
| CURRENT DATE: |
COMPANY ADDRESS:
BUSINESS SIZE:
Large ___ Small ___ Small Disadvantaged ___ Woman Owned Small Business ___ Other __________________
| CONTACT PERSON: |
| TELEPHONE : |
| E-MAIL: |
| FAX : |
| TAXPAYER IDENTIFICATION NO (TIN) OR SSN NO: |
| LINE OF PRODUCT: |
FINANCIAL INSTITUTION INFORMATION
NAME:
ADDRESS:
| ACH COORDINATOR NAME: |
| TELEPHONE NUMBER: |
NINE DIGIT ROUTING TRANSIT NUMBER:
DEPOSITOR ACCOUNT TITLE:
| DEPOSITOR ACCOUNT NUMBER: |
| LOCKBOX NUMBER: |
TYPE OF ACCOUNT: ___ CHECKING ___ SAVINGS ___ LOCKBOX
(Check One)
SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL:(could be the same as ACH Coordinator)
TELEPHONE :
Located on check or deposit slip at very bottom.
File details come from the government source that posted it. Updated .