Free CBP Form 401 - Automated Clearinghouse Credit Enrollment - Federal

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection AUTOMATED CLEARINGHOUSE CREDIT ENROLLMENT
19 CFR 24.26

(This form will be used to maintain point of contact information) Please type or print information Mark one: Date: Payer Company Name: Payer Company Address: New Enrollee Change of Information

Payer Contact Name(s): Payer Email Address: Payer Phone Number(s): Payer Identification Number:
(Importer, Social Security or CBP Assigned Number)

Fax: Filer Code:
(3 Character Broker ID)

If your company uses multiple payer ID's or filer codes, provide the number/code that would be used most frequently in the ACH Credit process.

Name of Company Official

Signature of Company Official

The completed enrollment form should be faxed or mailed to: U.S. Customs and Border Protection Revenue Division ACH Credit Applications 6650 Telecom Drive, Suite 100 Indianapolis, IN 46278 Telephone: (317) 298-1200 Ext. 1098 FAX: (317) 298-1259 E-mail: [email protected]

You must initiate a prenote, non-dollar amount ($0), with addendum record transaction and you must notify U.S. Customs and Border Protection (CBP) of the date of the prenote. Once prenote transaction has been completed then CBP will assign an effective date to begin using your account for live transactions.

TO BE COMPLETED BY U.S. CUSTOMS AND BORDER PROTECTION
Effective Date:
The effective date is the first date that the ACH Credit Payment may be originated.

Name of CBP Official

Signature of CBP Official
CBP Form 401 (06/09)