LAWRENCE LIVERMORE NATIONAL LABORATORY
FINANCE DEPARTMENT
Accounts Payable
Dear Vendor:
As a recipient of payments from Lawrence Livermore National Security, LLC, (LLNS)
organization may be able to take advantage of the Electronic Funds Transfer (EFT)
Program. EFT (a.k.a. direct deposit) may be more convenient for your organization. Direct
deposit payments are not subject to handling and mailing delays associated with checks. In
addition, EFT payments are automatically and securely deposited into your organization’s
designated bank account; they are sheltered from opportunities for misrouting, theft, and
forgery. An automated e-mail remittance advice can be sent to you as notification of any
payment deposited in your bank account by LLNS.
If you would like to receive direct deposit payments, please complete the form below and
return this entire page to the EFT Coordinator at the address on the bottom of this page. If
you have any questions, please e-mail
EFT-Request@llnl.gov
or call the PFS Help Desk at
(925) 424-4444.
AUTHORIZATION AGREEMENT FOR WIRE DEPOSITS (ACH CREDITS/DEBITS)
Company
SSN or Fed
Name____________________________________________________________________ Tax ID __________________________________________
Remittance
E-Mail
Address__________________________________________________________________Address__________________________________________
(Street Address, City, State, Zip Code)
(For Remittance Advice)
I (we) hereby authorize, Lawrence Livermore National Security, LLC, hereinafter called COMPANY, to initiate credit entries and, if
necessary, debit entries and adjustments for any credit entries made in error to my (our) bank account indicated below at the depository
financial institution named below, hereafter called DEPOSITORY, and to credit and/or debit the same to such account. I (we) acknowledge
that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.
Bank
______________________________________
_________________________________
Name
Branch
_______________________________________
_______________
_______________
City
State
Zip
Routing
Account
_____________________________________
_________________________________
Number
Number
(9 digit ABA number)
This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its
termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Telephone
Name(s)________________________________________Title:_______________________________ __________ Number________________________
(Please Print)
Date___________________________________________Signature_____________________________________________________________________
Lawrence Livermore National Security, LLC * Lawrence Livermore National Laboratory
P. O. Box 5001, Livermore, CA 94551 Telephone : (925) 424-4444 Fax: (925) 422-2384
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