RFQ 467353 - Enclosure D - Vendor ACH Authorization Form.pdf
PDF 51 KB Posted
- Attached to
- Medium Voltage Vacuum Breakers (2 Ea)
- Solicitation number
- 467353
- Issued by
-
Department of Energy Office of Science
About this file
The document is a Vendor ACH Authorization Form from Brookhaven National Laboratory, managed by Brookhaven Science Associates, LLC under contract with the U.S. Department of Energy. The form is designed to authorize electronic payments through the Automated Clearing House (ACH) system, allowing the laboratory to directly credit a vendor's bank account. The form requires vendors to provide detailed information including company name, vendor number, tax ID, financial institution details, routing number, and checking account number. The authorization remains in effect until Brookhaven National Laboratory receives written notification to terminate or modify the arrangement, in compliance with NACHA (National Automated Clearing House Association) regulations.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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:
File details come from the government source that posted it. Updated .