UNICORACH.pdf

PDF 84 KB Posted

Attached to
Nylon Fabric Mattress Ticking
Solicitation number
CT2363-24
Issued by

About this file

This document is a UNICOR, Federal Prison Industries, Inc. ACH Vendor/Miscellaneous Payment Enrollment Form. It is used for Automated Clearing House (ACH) payments with an addendum record that contains payment-related information processed through the Vendor Express Program. The form collects information such as the company name, Dun & Bradstreet number, taxpayer identification number, financial institution details, and authorized official signature for setting up ACH payments. The form is for vendors doing business with UNICOR, Federal Prison Industries, Inc., which is a federal program agency under the Department of Justice Bureau of Prisons Correctional Facilities. The document provides the agency's contact information and ACH format details.

The related federal contract opportunity is for "Nylon Fabric Mattress Ticking" under Solicitation Number CT2363-24. The solicitation is for 100% nylon fabric with specific weight, width, and color requirements to be used as exterior mattress ticking/cover. A Certificate of Conformance and related test data are required to be provided with each shipment. The contracting agency is the Department of Justice Bureau of Prisons Correctional Facilities.

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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): 15080001 ACH FORMAT: CTX

MAILING ADDRESS: UNICOR, Federal Prison Industries, Inc.

PO Box 11849 Lexington, KY 40578-1849

VENDOR PAYMENT CONTACT:

Carla Coleman

E-MAIL:

Carla.Coleman@usdoj.gov

TELEPHONE :

800-827-3168, x3308

FAX:

859-253-8877

PAYEE/COMPANY INFORMATION You must include your Dun & Bradstreet Number (DUNS #)

COMPANY NAME: DUN & BRADSTREET NUMBER: CURRENT DATE:

COMPANY ADDRESS:

CONTACT PERSON: TELEPHONE : E-MAIL: FAX :

TAXPAYER IDENTIFICATION NO (TIN) OR SSN NO: ADDITIONAL INFORMATION:

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 :

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