Electronic Payment Trading Partner Enrollment Agreement

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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.

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