OMB No. 1515-0218

 United States Customs Service

ACH APPLICATION

United States Customs Service Automated Clearinghouse Daily Statement Payment Program (This application will be used to communicate account information to Mellon Bank)

Date:

Action to be Taken:

Current ACH Payer Unit Number:

Requested Effective Date:

(Effective date should be at least 2 business days in the future)

Payer Company Name:

Payer Company Address:

Payer Contact Name:

FAX: 

Payer Telephone: 

Importer Number: (Include suffix)

OR 3 digit filer code:

(mm/dd/yyyy)

(mm/dd/yyyy)

Add
Change
Delete

(Enter country code if applicable)

(Enter country code if applicable)

 United States Customs Service A. C H APPLICATION O M B Number 1 5 1 5 - 0 2 1 8 United States Customs Service Automated Clearinghouse Daily Statement Payment Program (This application will be used to communicate account information to  Mellon Bank) Action to be Taken:

Customs Form 400 (081099)

Customs Form 400 (0 8 1 0 9 9) Form Assistant Page 1 of 2

Form Assistant
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