Unified Financial Management System (UFMS)

Vendor Request Form

This form must be electronically filled out, no handwritten forms will be accepted.

Request Type:

Date of Request:

Select the date the request is being submitted.

Purpose of Request:

Select the purpose of the vendor request.

_{If the vendor is required to register in SAM.gov, please have them do so before completing this form. SAM.gov Registration exceptions can be found in FAR 4.1102. The assumption is that the SAM.gov information is valid. If the information currently listed at SAM.gov or in the UFMS is incorrect, then the vendor should be contacted to update their SAM.gov information}

Is Vendor Required to Register in SAM?

If No. What is the FAR Exemption?

USDOJ Component Information

Requesting Component:

Component Contact:

Office Phone Number:

Vendor Type:

UFMS Security Organization:

Payment Type:

CCD: Cash Concentration or Disbursement - Select for corporate.
Check: Select if vendor is requesting to be paid by.
PPD: Prearranged Payment or Deposit - Select for personal account.

Prompt Pay Type:

Employee/Vendor/Payee Information

Vendor Name:

Enter the name of the vendor to be entered into the vendor table.

UEI-EFT:

Enter the UEI number and EFT indicator.

Cage Code:

Enter the UEI number and EFT indicator.

NCIC Code:

Enter the UEI number and EFT indicator.

Select either EIN/TIN or SSN and enter the number for that selection.

Street Address:

City, State, Zip:

Country:

Email Address:

Phone Number:

Fax Number:

Contact Name:

Select NCIC or TPID and enter the code for that selection.

AIN Code:

When TPID is selected, enter the code associated with that entered TPID code.

AIN Code:

When TPID is selected, enter the code associated with that entered TPID code.

Financial Institution Information

Bank Name:

Enter the banking institution name receiving funds.

Street Address:

Enter the street address for the banking institution.

City, State, Zip:

Enter the city, state and zip for the banking institution.

Country:

Bank Phone Number:

ABA Number:

Enter the ABA Routing number for the banking institution.

Account Type:

Select the appropriate account type.

Account Type:

Select the appropriate account type.

Account Number:

Enter the account number receiving the funds.

Re-enter Account Number:

Enter the number again in the Re-enter Account No field.

_{PRIVACY ACT STATEMENT: The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information 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.}