UNICORACH.pdf
PDF 84 KB Posted
- Attached to
- Mattress Ticking
- Solicitation number
- CT2394-26
About this file
This is an ACH Vendor/Miscellaneous Payment Enrollment Form used by UNICOR, Federal Prison Industries, Inc., to process electronic payments through the Automated Clearing House (ACH) system via the Vendor Express Program.
The form captures essential banking and vendor information required to facilitate ACH payments. Vendors must provide company details including legal name, Dun & Bradstreet Number, Taxpayer Identification Number (TIN) or Social Security Number, and company contact information. Financial institution details required include the bank's name and address, ACH coordinator contact information, nine-digit routing transit number, depositor account title and number, and account type designation (checking, savings, or lockbox). An authorized official must sign the form with their title and telephone number. The form is submitted to UNICOR's Vendor Payment Contact, Carla Coleman, at the agency's Lexington, Kentucky mailing address (PO Box 11849, Lexington, KY 40578-1849). The agency identifier is UNICOR with location code 15080001, and the ACH format utilized is CTX. Failure to provide complete information may delay or prevent payment receipt, and the TIN may be used for collection and reporting purposes related to delinquent government amounts.
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| A0001 Amendment Solicitation CT2394-26.pdf | ||
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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): 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 .