Enclosure (3) 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 BNL/BSA to process payments to vendors through Automated Clearing House (ACH) credit entries and correcting entries to the vendor's designated bank account.

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 name, routing/transit/ABA number, and checking account number. The Authorization section contains language indicating that the authorization remains in effect until BNL/BSA receives written notification to terminate or modify it, and that credit authorizations may only be revoked in accordance with NACHA (National Automated Clearing House Association) law. The form requires signature by an authorized representative along with their email, phone number, and date of authorization. This is a template form used for establishing payment processing procedures with vendors doing business with Brookhaven National Laboratory.