Form Details

Ach Vendor Payment Form is a payment form that can be used for any vendor. This form provides a space to enter the vendor name, amount owed and how often they are paid. The program also has a feature that allows you to export data in spreadsheet format, which may come in handy if you have other accounts payable software or need to send vendors reports on their balances due. Ach Vendor Payment Form is available as an add-on for QuickBooks Online Plus subscribers and can be downloaded from the App Store or Google Play Store free of charge.

This knowledge can help you comprehend better the details of the ach vendor payment form before starting filling it out.

QuestionAnswer
Form NameAch Vendor Payment Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdol ach form, owcp ach form, ACS, ach payment instruction form

Form Preview Example

ATTACHMENT 3

PAYMENT INFORMATION FORM

ACH VENDOR PAYMENT SYSTEM

This form is used for the ACH payments with an addendum record that carries payment-related information. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion.

PAPERWORK REDUCTION ACT STATEMENT

The information being collected on this form is required under the provision 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 Clearinghouse Payment System.

 

MEDICAL PROVIDER INFORMATION

 

 

 

 

Provider #:

 

 

 

Name:

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

Contact Person Name:

 

Telephone Number:

 

 

 

AGENCY INFORMATION

Name: U.S. Department of Labor-Office of Workers’ Compensation Programs

Address: c/o ACS- Department of Labor Project

P.O. Box 14600, Tallahassee, Florida 32317-4600

Contact Person Name:

Telephone Number: 1 (866) 335-8319 Toll Free

 

 

 

FINANCIAL INSTITUTION INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACH Coordinator Name:

 

 

 

 

 

 

 

 

Telephone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nine-Digit Routing Transit Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depositor Account Title:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depositor Account Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Account:

 

□ Checking

 

 

 

□ Savings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature and Title of Representative:

 

 

 

 

Telephone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SF Form 3881

Department of the Treasury

 

Financial Management Service

SF Form 3881

Department of the Treasury

 

Financial Management Service

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