"Electronic Payment Trading Partner Enrollment Agreement Form"

Electronic Payment Trading Partner Enrollment Agreement Form is a 2-page legal document that was released by the U.S. Air Force and used nation-wide.

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ELECTRONIC PAYMENT TRADING PARTNER ENROLLMENT AGREEMENT
BETWEEN CONTRACTOR AND
Aviano
AIR FORCE BASE (NAFI)
AT
Unit 6122 Box 45, APO AE 09604-2245
(Base mailing Address)
BASE FAX NO: 011-39-0434-651077
BASE COMM PHONE NO: 011-39-0434-305272
BASE POC E-MAIL ADDRESS: lisa.silvi@aviano.af.mil
This form is used to enroll for electronic funds transfer (EFT) payment. The information will be used by the NAFI to transmit payment data
by electronic means to your financial institution. Return the completed form to the NAFI at the above address.
EFT ENROLLMENT TYPE ('X' New or Change):
NEW:
CHANGE:
VENDOR CODE:
(To be completed by NAFI)
Customer
Customer's Financial Institution
Name :
Name:
Forwarding Address:
Address:
Taxpayer Identification Number (TIN):
Bank Contact:
Or Social Security Number:
Telephone:
EFT addenda information required by Contractor to accompany payment
Bank Transit Routing #:
(See item 3 on reverse side)
State Side Banks use 9-Digit Rouitng Number
(80 Characters or less)
Overseas Banks use SWIFT Number
BASE IS TO FAX PAPER REMITTANCE INFORMATION TO:
Customer Account Number:
n/a
NAME:
Name Of Account, If different than Contractor Name:
n/a
FAX NUMBER:
n/a
TELEPHONE NUMBER:
Account Type: ('X' one of the following)
Checking:
Savings:
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. 3332 and 31 CFR
210. PURPOSE: This information will be used by Air Force Services to transmit payment data, by electronic means to vendor's financial institution. ROUTINE USE: The information collected
on this form may be shared with parties' financial institutions for electronic funds transfers (EFT). Failure to provide the requested information may delay or prevent the receipt of payments
through the Automated Clearing House (ACH) Payment System.
ELECTRONIC PAYMENT TRADING PARTNER ENROLLMENT AGREEMENT
BETWEEN CONTRACTOR AND
Aviano
AIR FORCE BASE (NAFI)
AT
Unit 6122 Box 45, APO AE 09604-2245
(Base mailing Address)
BASE FAX NO: 011-39-0434-651077
BASE COMM PHONE NO: 011-39-0434-305272
BASE POC E-MAIL ADDRESS: lisa.silvi@aviano.af.mil
This form is used to enroll for electronic funds transfer (EFT) payment. The information will be used by the NAFI to transmit payment data
by electronic means to your financial institution. Return the completed form to the NAFI at the above address.
EFT ENROLLMENT TYPE ('X' New or Change):
NEW:
CHANGE:
VENDOR CODE:
(To be completed by NAFI)
Customer
Customer's Financial Institution
Name :
Name:
Forwarding Address:
Address:
Taxpayer Identification Number (TIN):
Bank Contact:
Or Social Security Number:
Telephone:
EFT addenda information required by Contractor to accompany payment
Bank Transit Routing #:
(See item 3 on reverse side)
State Side Banks use 9-Digit Rouitng Number
(80 Characters or less)
Overseas Banks use SWIFT Number
BASE IS TO FAX PAPER REMITTANCE INFORMATION TO:
Customer Account Number:
n/a
NAME:
Name Of Account, If different than Contractor Name:
n/a
FAX NUMBER:
n/a
TELEPHONE NUMBER:
Account Type: ('X' one of the following)
Checking:
Savings:
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. 3332 and 31 CFR
210. PURPOSE: This information will be used by Air Force Services to transmit payment data, by electronic means to vendor's financial institution. ROUTINE USE: The information collected
on this form may be shared with parties' financial institutions for electronic funds transfers (EFT). Failure to provide the requested information may delay or prevent the receipt of payments
through the Automated Clearing House (ACH) Payment System.
ELECTRONIC PAYMENT TERMS AND CONDITIONS
The Debit Collection Improvement Act of 1996 mandates all Federal government payments be made by Electronic Funds Transfer (EFT) as of 1 Jan 99. As
such, payment terms between NAFI and Contractor is by EFT.
Contractor agrees to accept payment from the NAFI through EFT. The NAFI can rely exclusively on the information provided by the Contractor on this
enrollment form. This applies to and amends all existing agreements with the NAFI by incorporating the following terms and conditions for electronic payment.
NAFI will initiate payment to Contractor based on the following:
1. EFT payment will be made to the financial institution to credit the account number as stated on enrollment form.
2. EFT payment is in a National Automated Clearing House (NACHA) CCD+ format.
3. Remittance information is limited to repetitive (non-changing) information, such as, customer number, store number, etc.
4. The bank information contained on this enrollment form signed by Contractor's authorized representative contains the Contractor's correct account
information. Contractor's authorized representative must notify NAFI in writing of any change to said Contractor's bank account information 10 days prior NAFI's
forthcoming payment due date. This allows the NAFI to make the necessary account information changes within their EFT payment system. The NAFI will be
considered harmless for any loss that may arise solely by reason of error, mistake or fraud regarding the bank information provided by Contractor on an original
enrollment or corrected enrollment form.
5. EFT payment is initiated within the normal terms of NAFI's agreement with Contractor. NAFI's EFT terms and conditions neither enlarge or diminish the
respective rights and obligations of NAFI within any applicable commercial agreement. The payment due date is not affected. NAFI will consider payment
made when Contractor's financial institution has received or has control of the payment transaction. This will generally occur within three (3) calendar days
following EFT payment by the NAFI. Any loss of data at that point will be borne by Contractor unless the loss is due to sole negligence of the NAFI's originating
bank.
If the NAFI EFT payment value date is a non-banking day, the EFT value date automatically changes to the next banking business day. In all cases, the
banking day is defined as the day the EFT originating bank (NAFI) and the receiving bank (Contractor) is available to transmit and receive the EFT payment.
Contractor should notify the NAFI immediately if payment is not received as described in item 4 (above). The NAFI shall have a reasonable time (not to exceed
ten (10) business days)) to make said payment.
6. The NAFI has the right to adjust future payments or initiate either an EFT reversal or an ACH debit (with REVERSAL as the entry description) for an EFT
payment amount if EFT payment previously paid is a duplicate payment, overpayment, fraudulent payment or payment error.
CONTRACTOR'S AUTHORIZED REPRESENTATIVE
SIGNATURE
DATE
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