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Byrnes Department of Homeland Security ACH Application

U.S. Customs and Border Protection Automated Clearinghouse Daily Statement Payment Program (This application will be used to communicate account information to Federal Reserve Bank of Cleveland)

Date:
Action to be Taken: Add Change Delete
Current ACH Payer Unit Number:
Requested Effective Date:

(Effective date should be at least 3 business days in the future)

Payer Company Name:
Payer Company Address:
Address (line 2):
Payer Contact Name:
Payer Email Address:
Payer Telephone: (Country code)
Payer Fax: (Country code)
Importer Number: (Include suffix)
OR 3 digit filer code:
Bank Name:

Bank must be a National Automated Clearinghouse Association (NACHA) participant.

Address:
Bank Telephone Number:
ACH Bank Transit Routing Number
ACH Bank Account Number
  To ensure the accuracy of the account information, it is requested that written verification (obtained from your bank) be completed and accompany this application. The ACH payer will be responsible for defaults, which result from incomplete or erroneous account information when written verification is not submitted and certified by bank personnel. Please ensure that the bank transit routing and account numbers on the ACH application have been verified by your bank before sending to the Revenue Division.
Name of CBP Broker/Filer:
3 digit filer code:
Contact Name:
Telephone:
U.S. Customs and Border Protection ABI Client Representative of Customs Broker/Filer:
Name of Authorizing Company Official
Signature of Authorizing Company Official