📄 Extracted Text (9,845 words)
EFTA00186185
73-0,0(Ava- o4/oc, 05/0 5
is a siteck-tin...sC s
EFTA00186186
U.S. Department of Justice
United States Attorney
Southern District of Florida
500 South Australian Avenue, Suite 100
West Palm Beach, Florida 33401423$
Tel: (561)8104711
Fax: (561) 8104777
June 007
VIA FACSIMILE
Colonial Bank
Hoover, AL 35243
Re: Federal Grand Jury Subpoenas OLY-01 and OLY-28
Dear Ms. Muller:
I write to follow up on Colonial Bank's response to two federal grand jury subpoenas
numbered OLY-01 and OLY-28. Colonial Bank has responded to both of these subpoenas, but
it appears that some items are incomplete.
I have enclosed copies of the subpoenas, but, in short, the seek all account o
documentation and correspondence related to Jeffrey E stein =, [or
Janusz Banasiak [or Banasiar], Alfredo Rodriguez,
NES, LLC, Jeffrey Epstein Household, and JEGE, Inc. The subpoenas also ask for account
statements, canceled checks, and billing statements for accounts and credit cards related to those
individuals/entites for the period of January 1, 2004 through December 31, 2006.
The items that appear to be missing are:
(1) Billing statements for VISA account number for the period of
February 1, 2005 through April 30, 2005.
EFTA00186187
Anita Muller-Page 2
(2) Billing statements for the following VISA account numbers for the period of
004 through December 31, 2006:
(3) Account statements and canceled checks for thei sio id of Janu 1, 2004 throw
December 31, 2006, for accounts in the names of [or and/or
(4) Account statements, account opening documents, correspondence and canceled
checks (front and back), related to a multitude of accounts related to Mr. Epstein, including
account numbers
From the review of the documents we have received thus far, it appears that there
probably are several more accounts related to Mr. Epstein and the other listed
individuals/entities. For example, there appear to be several more VISA cards associated with
the NES, LLC master account. So, in addition to providing the items specifically listed in this
letter, please re-review the records of the bank to determine if there are more documents
responsive to the two subpoenas.
I have enclosed another Certification of Business Records to authenticate and records
that you produce in response to this letter. Please send the Certification and the records to
Special Agen , Federal Bureau of Investigation, ININIMINIMIM
West Palm Beach, FL 33401.
If you have any questions, please feel free to contact me at Thank you for
your assistance.
Sincerely,
R. ALEXANDER ACOSTA
UNITED STATES ATTORNEY
By:
Assistant United States Attorney
EFTA00186188
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF FLORIDA
IN RE FEDERAL GRAND JURY SUBPOENAS
OLY-01 AND OLY-28
ADDRESSED TO COLONIAL BANK
CERTIFICATION REGARDING DOMESTIC RECORDS
OF REGULARLY CONDUCTED ACTIVITY
I, the undersigned, , declare that I am employed by
Colonial Bank in the position of , and, by reason of my
position, am authorized and qualified to make this declaration.
1. In my employment with Colonial Bank, I am familiar with the business records it
maintains.
2. I certify that the records attached to this certification:
(a) were made at or near the time of the occurrence of the matters set forth
therein, by or from information transmitted by, a person with knowledge of
those matters;
(b) were kept in the course of regularly conducted business activity; and
(c) were made by the regularly conducted activity as a regular practice.
2. Among the records so maintained are the attached records itemized in Appendix A
(Document Inventory).
3. I further certify that the documents attached hereto are responsive to the Grand Jury
Page 1 of 2
EFTA00186189
Subpoenas served upon Colonial Bank.
4. I further certify that Colonial Bank has no documents responsive to request number
in Grand Jury Subpoena number . [Fill in or strike out as appropriate.]
Pursuant to 28 U.S.C. § 1746, I declare under penalty of perjury that the foregoing
information is true and correct.
Executed this day of , 2007.
Place of execution:
Signature
Page 2 of 2
EFTA00186190
APPENDIX A
DOCUMENT INVENTORY
The documents submitted are as follows:
I
Signature of Records Custodian:
EFTA00186191
06/19/2007 14:39 FAX 5618021787 USA0 WPII FL li!)001
*********************
t*s TX REPORT s*s
**************s******
TRANSMISSION OK
TX/RX NO 4930
CONNECTION TEL
SUDADDRESS .
CONNECTION ID
ST. TIME 06/19 14:38
USAGE T 00.55
PGS. SENT 6
RESULT OK
U.S. Department of Justice
United States Attorney
Southern District of Florida
Mil ve, 4th Floor
.,50 1.Az wiati
West Palm Beach, Florida 33401
FACSIMILE COVER SHEET
TO: attn: Anita Muller
DATE: June 19, 2007
FAX NO. # OF PAGES: (7,
PHONE NO. RE: Grand Jury Subpoenas OLY-01 & OLY-28
FROM:
PHONE NO.
COMMENTS:
EFTA00186192
U.S. Department of Justice
United States Attorney
Southern District of Florida
SOO S. Australian Ave, 4th Floor
01
FACSIMILE COVER SHEET
TO: mum. attn: Anita Muller
DATE: June 19, 2007
FAX NO. # OF PAGES: G
PHONE NO. RE: Grand Jury Subpoenas OLY-01 & OLY-28
FROM: Millaillallitssistant U.S. Attorney
PHONE NO.
COMMENTS:
EFTA00186193
United States District Couri
SOUTHERN DISTRICT OF FLORIDA
TO: COLONIAL BANK SUBPOENA TO TESTIFY
BEFORE GRAND JURY
FGJ 05-02(WPB)-FriJNo. OLY-01
SUBPOENA FOR:
PERSON DOCUMENTS OR OBJECT'S]
YOU ARE HEREBY COMMANDED to appear and testify before the Grand Jury ofthe United States District
Cowl at the place, date and time specified below.
PLACE: ROOM:
Palm Beach County Courthouse Room 4-A
Juvenile Courts Building
205 N. Dixie Highway
DATE AND TIME:
West Palm Beach, Florida 33401
August 18, 2006
(Temporary location for the United States District Courthouse, West Palm Beach)
9:00ani
YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s):
All applications, signature cards credit or back round invests ations conducted, and correspondence
related to Jeffrey Epstein, I= for Janusz Banasiak,
Alfredo Rodriguez, and/or VISA Account Number
For the period of January 1, 2004 to the present, all monthly billing statements, individual charge
invoices, repayment records disclosing the dates, amounts, and method of r a e t, and checks used
to make repayments (front and back) for VISA Account Number .
Please coordinate your com liance of this subpoena and confirm the date and time of our a earance with
Special Agen Federal Bureau of Investigation, Telephone:
O Please see additional information on reverse
This subpoena shall remain in effect until you are granted leave to depart by the court or by an officer acting on behalf
of the court.
CLERK DATE:
August 2, 2006
(BY) DEPUTY CLERK
This subpoena is issued upon application t U.S. Attorney
of the U States of America
500 So. Australian Avenue, Suite 400
235
Te
Fa
'If not applicable, enter "none." o bc :c, ',eu dA0110 FORM ORD-227
EFTA00186194
JAN.86
RETURN OF SERVICE'
RECEIVED
BY SERVER
DATE/J'4 3 PLACkk i paim.geoci. n
SERVED DATE PLACE fi
036437C6 COI4e4- Pi. C (-1/ 4 12
/ 4K
/
SERVED ON (NAME)
C O 7O A./ t li Lax-k ik ( 7 A -k44- AV/( -e r)
SERVED TITLE
?B+ C.(442--
STATEMENT OF SERVICE FEES
TRAVEL SERVICES TOTAL
DECLARATION OF SERVICE'
I declare under penalty of perjury under the laws of the United States of America that the foregoing Information contained in the Return of Service and
Statement of Service Fees is true and correct.
Executed on Og/02/0‘
DATE Signature of Serve
Address of Server
ADDITIONAL INFORMATION
1.As to who may serve a subpoena and the manner of Its service see Rule 17(d). Federal Rules of Criminal Procedure, or
Rule 45(e), Federal Rules of Civil Procedure.
2."Fees and mileage need not be tendered to the witness upon service of a subpoena issued on behalf of the United
States or an officer or agency thereof (Rule 45(c), Federal Rules of Civil Procedure; Rule 17(d), Federal Rules of Criminal
Procedure) or on behalf of certain Indigent parties and criminal defendants who are unable to pay such costs (28 USC
1825, Rule 17(b) Federal Rules of Criminal Procedure)"
EFTA00186195
United States District Court
SOUTHERN DISTRICT OF FLORIDA
TO: COLONIAL BANK SUBPOENA TO TESTIFY
BEFORE GRAND JURY
FGJ 05-02(WPB)-Fri./No. OLY-01
oover,
SUBPOENA FOR:
PERSON DOCUMENTS OR OBJECT'S]
YOU ARE HEREBY COMMANDED to appear and testify before the Grand Jury of the United States District
Court at the place, date and time specified below.
PLACE: ROOM:
Palm Beach County Courthouse Room 4-A
Juvenile Courts Building
205 N. Dixie Highway
DATE AND TIME:
West Palm Beach, Florida 33401
August 18, 2006
(Temporary location for the United States District Courthouse, West Palm Beach)
9:00am
YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s):
All applications, signature bit c riagrouialage ducted, and corres
related to Jeffrey Epstein, [or z Banasiak,
MM, Alfredo Rodriguez, and/or VISA Account Number
For the period of January 1, 2004 to the present, all monthly billing statements, individual charge
invoices, repayment records disclosing the dates, amounts, and m t, and checks used
to make repayments (front and back) for VISA Account Number
Please coordinate our com liance of this subpoena and confirm the date and ce with
Special Agent ederal Bureau of Investigation, Telephone
O Please see additional information on reverse
This subpoena shall remain in effect until you are granted leave to depart by the court or by an officer acting on behalf
of the court.
CLERK DATE:
August 2, 2006
(BY) DEPUTY CLERK
This subpoena is issued upon application S.
of the UaiCed State of America Attorney
500 So. Australian Avenue, Suite 400
West Palm Beach, FL 33401-6235
Tel
Fa
*If not applicable, enter "none. In be u,ed I.0 or A0110 FORM ORD-227
EFTA00186196
JAN.86
. ,
RETURN OF SERVICE,
RECEIVED DATW03/ 0c PLACtoes rp ast s, ? ea, a _--(
BY SERVER
CF.- I
SERVED DATE0
876ild,
PLACE
00fre-1-
/
a_ ((Joel //I'M' )
SERVED ON (NAME)
Colo &It sl L_ (Ra....L.IC (4-7,..;4. 4 Liffe r)
SERV; TITLE
1-8 I --7.5c:f..42- 4 8--e-if
- —
STATEMENT OF SERVICE FEES
TRAVEL SERVICES TOTAL
DECLARATION OF SERVICE2
I declare under penalty of perjury under the laws of the United States of America that the foregoing Information contained In the Return of Service and
Statement of Service Fees is true and correct.
Executed on oeingAtc.
DA E Signature of Serve
Address of Server
ADDITIONAL INFORMATION
1.As to who may serve a subpoena and the manner of its service see Rule 17(d). Federal Rules.of Criminal Procedure, or
Rule 45(c), Federal Rules of Civil Procedure.
2."Fees and mileage nood not bo tendered to the witness upon service of a subpoena issued on behalf of the United
States or an officer or agency thereof (Rule 45(e), Federal Rules of Civil Procedure; Rule 17(d), Federal Rules of Criminal
Procedure) or on behalf of certain Indigent parties and criminal defendants who are unable to pay such costs (28 USC
1825, Rule 17(b) Federal Rules of Criminal Procedure)"
EFTA00186197
U.S. Departmen,t of Justice Request for Financial Information (Authorization,
Washington, D.C. 20530 Purchase Order, Receiving Report)
This form sball only be wed when requesting financial records of individuals and partactskips of five a kiver individuakt.
I I'urchase Order Number/12CW: 2 Date Order Prepared: 3 Case Number: (Optional)
ill), I - 19 6-1z , 08/02/2006 FCJ 05-02(WPB) NO.051-01 (OLY-Ol)
Section A - Authorization and Purchase Order
4 Names and Add ion: Attn.: Anita Mulle
Colonial Bank, " ' oover, AL 35243 - Fa-
5 Deliver To: Special Agen Federal Bureau of Investigation, G Return I /ate
Suite 500, Florida 33401, Tel.: 08/18/2006
7 Remarks: FOR REIMBURSEMENT PLEASE RETURN THIS FORM, THE RECORD OP
SERVICES, AND A COPY OF THE SUBPOENA.
8 Name of Requestor: (7)tioe or Print) 9 Tele hone Numhcr: 10 Date of request:
AUSA 08/02/2006
Section B - Financial Institution Invoice
No Payment Shall Be Made Unless Expenses Are Itemized Below Or On Your Forrn To Be Attached.
11 Service/Financial Records Provided: Quantity Amount
thiit Price
Cost Pa
Please note that reimbursement cannot be made for the records pertaining to 0.25 Copy
corporations or large partnerships of six or more.
IMPORTANT: The DCIA Mandates the use of EFT/DD. In order to receive
payment complete the attached EFT enrollment Form.
11.00 Hour Clerical
Tech
17.00 Hour Manager
or Supervisor
Do not proceed with compliance: If cost will exceed $300 without prior approval of
Assistant U.S. Attorney/Budget Officer.
PLEASE REFERENCE THE ABOVE DCNN ON YOUR INVOICE FOR PAYMENT.
I 2a Signature of Financial Institution Official: 126 Phone of Financial Institution Official: 13 Date Signed: Total Amount Claimed
By Financial Institution
16 Disallowance
Section C - Receiving Report
(See Attached)
14 I certify that the articles and services listed were received: 17 Net to
15 Date Received:
Financial
Institution
IS Right to Financial Privacy Act - Public Law 95-630 19 Signature of Approval Official:
(12 U.S.C. 3401.3422) Request Pursuant To: (Cheek One Ono) OBJECT
SECTION CLASS
O 3404 Customer Authorization 2540
O 3405 Administrative Subpoena or Summons 2541
CY CC 1 2 4 PROJ
O 3406 Search Warrant 2540
O 3407 Judicial Subpoena 2540
O 3408 Formal Written Request 0 00
O 3413 Grand Jury Subpoena
21 Schedule and Voucher Number:
O 3414 Special Procedures 2540 DCN
22 Remarks:
Funds Available
Date Form onn2i
Budget Officer I APR 84
This form was electronically produced by Nile Federal Roma. Inc. Page I of 3
EFTA00186198
GENERAL
This is a multi-purpose form designed to sent as an Authorization, Purchase Order, Itemized Invoice, receiving Report and Payment voucher in
conjunction with - requests for financial information," pursuant to the Right to Financial Privacy Act of 1978, P.L. 95-630, Title XL, 12 U.S.C. 3415.
NOTE:
Payments under this purchase order will be due on the 30'a calendar day after the date of actual receipt of a proper invoice in the office designated to
receive the invoice.
The Prompt Payment Act, Public Law 97-177,96 Stat. 85 (31 U.S.C. ISO), is applicable to payments under this purchase order and requires the payment
to contractors of interest or overdue payments and improperly taken discounts. Determination of interest due will be made in accordance with the
provision of the Prompt Payment Act and the Office of Management and Budge Circular A-125.
PREPARATION INSTRUCTIONS
ITEM 1 - A Purchase Order Number will be preprinted on each form. This number will be used for reference purposes on any correspondence relating to this
specific request for financial information.
ITEM 2 - Self explanatory.
ITEM 3 - This block may be used to identify the specific case for which the financial information is required. This block may be left blank.
SECTION A - AUTHORIZATION AND PURCIIASE ORDER (To be completed by the requesting official).
ITEM 4 - Enter the name and mailing address of the financial institution being requested to furnish financial information.
ITEM 5 - Enter the and address to which the financial information is to be sent by the financial institution. This will normally be the name and the address of the
requesting official.
ITEM 6 - Enter the date the financial information is required.
ITEM 7 - Include, if appropriate, any pertinent information related to the purchase order not provided for elsewhere on the form
ITEM 8, 9 and 10 - Self-explanatory.
SECTION B - FINANCIAL INSTITUTION INVOICE (To be completed by the financial institution).
ITEM II - Self-explanatory. Completion of this block constitutesan itemized bill or invoice for reimbursement for the costs incurred in providing the infortnation
requested. The DCIA Mandates the use of EFT/DD. In order to receive payment complete the attached EFT enrollment Form.
ITEM 12 and 13 - Self-explanatory.
SECTION C - RECEIVING REPORT (To be completed by the requesting official, when the requested financial information has been delivered).
ITEM 14 and 15 - Self-explanatory.
ITEM 16 - This block should be used to reflect any differences between the amount claimed by the financial institution and the correct amount to be reimbursed.
Differences may result form computation errors, or failure of the financial institution to deliver information requested.
ITEM 17 - Enter the amount certified to he proper for payment.
ITEM 18 - Check the box which identifies the appropriate procedure authorized by the Act, which necessitates the request for financial information.
ITEM 19 and 20 - These blocks must be signed and dated by an official of the organization whose funds will be charged. His or her signature constitutes a
statement that the records to which the invoice refers were required for official business and were provided by the financial institution in accordance with the
ordering instrument.
ITEM 21 • The Schedule and Voucher Number will be entered by the office which actually schedules the approved amount for payment by the Treasury
Department.
ITEM 22 - Enter, if appropriate, any data not provided for elsewhere on the receiving report, such as, reasons for any claim amounts disallowed.
IAORM OBO-21I
APR. 84
Par 2 of 3
EFTA00186199
VENDOR ELECTRONIC FUNDS TRANSFER (EFT)
ENROLLMENT FORM
Please comply to this information if you have not done so already
I
PAYEE/COMPANY INFORMATION:
Vendor Company Name:
Address:
Taxpayer ID Number
Contact Person Name
Telephone Number
E-mail Address (if you would
like to be notified via e-mail)
FINANCIAL INSTITUTION INFORMATION:
Bank Name
Bank Address
Bank Phone Number
Nine Digit ABA Routing Transit Number
Type of Account (Checking or Saving)
Depositor Account Number
Signature of Vendor's
Authorizing Official
Name & Title of Authorizing
Official
Please Return or Fax to:
U.S. Attorney's Office
Southern District of Florida
99 NE 4 street, Suite 200
Miami, FL.
Attention:
Fax Number:
The Debt Collection Improvement Act of 1996 requires that payments made by the Federal government, including vendor
payments, must be made by electronic funds transfer (EFT). A benefit of receiving payments by EFT is that your funds
are directly deposited to your account at a financial institution and are available to you on the date of payment.
If you have questions regarding the delivery of the remittance information, please contact the financial institution where
your account is held.
If you have any questions on the completion of this form, please contact , at 305-961-9254.
FORM O11D-211
APR. 84
Page 1 of
EFTA00186200
U.S. Department of Justice Request for Financial Information (Authorization,
Washington, D.C. 20530 Purchase Order, Receiving Report)
This form shall only be rated when requesting financial records of individuals and partnerships of five or fewer individuals.
I Purchase Order Number/DCNa: 2 Date Order Prepared: 3 Case Number (Optional)
11011.1960 08/02/2006 FGJ 05-02(WPB) NO.051-01 (OLY-01)
Section A - Authorization and Purchase Order
4 Names and Ad tion: Attn.: Anita Muller, Research Dept.
Colonial Bank, borer, AL 35243 -
5 Deliver To: Special Age Federal Bureau of 1nvestigatio 6 Return Date
Suite 500, Florida 33401 08/18/2006
7 Ranatits: FOR REIMBURSEMENT PLEASE RETURN THIS FORM, THE RECORD OF
SERVICES, AND A COPY OF THE SUBPOENA.
8 Name ammilains) 10 Date of request:
AUSA 08/02/2006
Section B - Financial Institution Invoice
No Payment Shall Be Made Unless Expenses Arc Itemized Below Or On Your Forrn To Be Attached.
I I Service/Financial Records Provided: Quantity Amount
Unit Price
Cost Per
Please note that reimbursement cannot be made for the records pertaining to 0.25 Copy
corporations or large partnerships of six or more.
IMPORTANT: The DCIA Mandates the use of EFT/DD. In order to receive
payment complete the attached EFT enrollment Form.
11.00 Hour Clerical
Tech
17.00 Hour Manager
or Supervisor
Do not proceed with compliance: If cost will exceed $300 without prior approval of
Assistant U.S. Attorney/Budget Officer.
PLEASE REFERENCE THE ABOVE DCNN ON YOUR INVOICE FOR PAYMENT.
12a Signature of Financial Institution Official: 12b Phone ofFinancial Institution Official: 13 Date Signed: Total Amount Claimed
By Financial Institution
16 Disallowance
Section C- Receiving Report (See Attached)
1
14 I certify that the articles and services listed were received: 17 Net to
15 Date Received:
Financial
Institution
18 Right to Financial Privacy Act - Public Law 95.630 19 Sign lure of Approval Official:
(12 U.S.C. 3401.3422) Request Pursuant To: (Check One Onfr) OBJECT
SECTION CLASS
O 3404 Customer Authorization 2540 20 Ate— Cod..
O 3405 Administrative Subpoena or Summons 2541
fY 2 3 4 PROJ
O 3406 Search Warrant 2540
O 3407 Judicial Subpoena 2540
O 3408 Formal Written Request 2540
O 3413 I Grand July Subpoena 2545
21 Schedule and Voucher Number:
O 3414 Special Procedures 2540 DCtt
22 Remarks:
Funds Available
Date I Form OBIY211
Budget Officer APR 84
I
This form was eketronically produced by Elite Federal Forum. Inc. Page t of 3
EFTA00186201
GENERAL
This is a multi-purpose form designed to sene as an Authorization, Purchase Order, Itemized Invoice, receiving Report and Payment voucher in
conjunction with "requests for financial information," pursuant to the Right to Financial Privacy Act of 1978, P.L. 95-630, Title XL, 12 U.S.C. 3415.
NOTE:
Payments under this purchase order n111 be due on the 3e calendar day after the date of actual receipt of a proper Invoice In the office designated to
receive the invoice.
The Prompt Payment Act, Public Law 97-177,96 Stat. 85 (31 U.S.C.180), is applicable to payments under this purchase order and requires the payment
to contractors of interest or overdue payments and improperly taken discounts. Determination of interest due will be made In accordance with the
provision of the Prompt Payment Act and the Office of Management and Budge Circular A-125.
PREPARATION INSTRUCTIONS
ITEM I - A Purchase Order Number will be preprinted on each form. This number will be used for reference purposes on any correspondence relating to this
specific request for financial information.
ITEM 2 - Self explanatory.
ITEM 3 - This block may be used to identify the specific case for which the financial information is required. This block may be left blank.
SECTION A - AUTHORIZATION AND PURCHASE ORDER (To be completed by the requesting official).
ITEM 4 - Enter the name and mailing address of the financial institution being requested to furnish financial information.
ITEM 5 - Enter the and address to which the financial information is to be sent by the financial institution. This will normally be the name and the address of the
requesting official.
ITEM 6 - Enter the date the financial information is required.
ITEM 7 - Include, if appropriate, any pertinent information related to the purchase order not provided for elsewhere on the form
ITEM 8, 9 and 10 - Self-explanatory.
SECTION B - FINANCIAL INSTITUTION INVOICE (To be completed by the financial institution).
ITEM I I - Self-explanatory. Completionof this block constitutesan itemized bill or invoice for reimbursement for the costs incurred in providingthe information
requested. The DCIA Mandates the use of EFT/DD. In order to receive payment complete the attached EFT enrollment Form.
ITEM 12 and 13 - Self-explanatory.
SECTION C - RECEIVING REPORT (To be completed by the requesting official, when the requested financial information has been delivered).
ITEM 14 and 15 - Self-explanatory.
ITEM I6 - This block should be used to reflect any differences between the amount claimed by the financial institution and the correct amount to be reimbursed.
Differences may result form computation errors, or failure of the financial institution to delner information requested.
ITEM 17 - Enter the amount certified to be proper for payment.
ITEM 18 - Check the box which identifies the appropriate procedure authorized by the Act, which necessitates the request for financial information.
ITEM 19 and 20 - These blocks must be signed and dated by an official of the organization whose funds will be charged. His or her signature constitutes a
statement that the records to which the invoice refers were required for official business and were provided by the financial institution in accordance with the
ordering instrunrnt.
ITEM 21 - The Schedule and Voucher Number will be entered by the office which actually schedules the approved amount for payment by the Treasury
Department.
ITEM 22 - Enter, if appropriate, any data not provided for elsewhere on the receiving report, such as, reasons for any claim amounts disallowed.
FORM OBE-21I
APR. 84
Page 2 orI
EFTA00186202
VENDOR ELECTRONIC FUNDS TRANSFER (EFT)
ENROLLMENT FORM
Please comply to this information if you have not done so already
PAYEE/COMPANY INFORMATION:
Vendor Company Name:
Address:
Taxpayer ID Number
Contact Person Name
Telephone Number
E-mail Address (If you would
like to be notified via e-mail)
FINANCIAL INSTITUTION INFORMATION:
Bank Name
Bank Address
Bank Phone Number
Nine Digit ABA Routing T ansit Number
Type of Account (Checking or Saving)
Depositor Account Number
Signature of Vendor's
Authorizing Official
Name & Title of Authorizing
Official
Please Return or Fax to:
U.S. Attorney's Office
Southern District of Florida
99 NE 4 street, Suite 200
Miami, FL.
Attention:
Fax Number:
The Debt Collection Ithprovement Act of 1996 requires that payments made by the Federal government, including vendor
payments, must be made by electronic funds transfer (EFT). A benefit of receiving payments by EFT is
ℹ️ Document Details
SHA-256
69a89cfdcb3992ff1ed8c37263c18a946994a10f315681db47da553b3ad86e8f
Bates Number
EFTA00186185
Dataset
DataSet-9
Document Type
document
Pages
71
Comments 0