----------------------------------------------------- -----------------
  **ACH VENDOR/MISCELLANEOUS PAYMENT**                  OMB No. 1510-056

  **ENROLLMENT FORM**                                   Expiration Date
                                                        06/30/93
  ----------------------------------------------------- -----------------

This form is used for Automated Clearing House (ACH) payments with an
addendum record that contains payment related information processed
through the Vendor Express Program Recipients of these payments should
bring this information to the attention of their financial institution
when presenting this form for completion.

+-----------------------------------------------------------------------+
| **PRIVACY ACT STATEMENT**                                             |
|                                                                       |
| The following information is provided to comply with the Privacy Act  |
| of 1974 (P.L. 93)579). All information collected on this form is      |
| required under the provisions of 31 U.S.C. 33Z 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.                                                               |
+-----------------------------------------------------------------------+

**AGENCY INFORMATION**

+-----------------------------------------------------------------------+
| FEDERAL PROGRAM AGENCY:                                               |
|                                                                       |
| **U. S. Geological Survey**                                           |
+-----------------------------------------------------------------------+

+-------------------+-----------------------+--------------------------+
| AGENCY            | AGENCY LOCATION CODE  | ACH Format:              |
| IDENTIFIER:       | (ALC):                |                          |
|                   |                       | **CCD+**                 |
|                   | **14-08-0001**        |                          |
+-------------------+-----------------------+--------------------------+

+-----------------------------------------------------------------------+
| ADDRESS:                                                              |
|                                                                       |
| **12201 Sunrise Valley Drive, Mail Stop 270, Reston Virginia 20192**  |
+-----------------------------------------------------------------------+

+------------------------------+---------------------------------------+
| CONTACT PERSON NAME:         | TELEPHONE NUMBER:                     |
|                              |                                       |
| **Brenda Fulk**              | **(703) 648-7654 Fax: (703)           |
|                              | 648-7707**                            |
+------------------------------+---------------------------------------+

  -----------------------------------------------------------------------
  CONTRACT/PURCHASE ORDER NO.: FFS VENDOR CODE:

  -----------------------------------------------------------------------

**PAYEE/COMPANY INFORMATION**

+----------------------------------+-----------------------------------+
| NAME:                            | SSN NO. OR TAXPAYER ID:           |
|                                  |                                   |
| NO.                              |                                   |
+----------------------------------+-----------------------------------+

  -----------------------------------------------------------------------
  ADDRESS:

  -----------------------------------------------------------------------

  ----------------------------------- -----------------------------------
  CONTACT PERSON NAME:                TELEPHONE NUMBER:

  ----------------------------------- -----------------------------------

**FINANCIAL INSTITUTION INFORMATION**

  -----------------------------------------------------------------------
  NAME:

  ADDRESS:
  -----------------------------------------------------------------------

  ------------------------------------------- ---------------------------
  ACH COORDINATOR NAME:                       TELEPHONE NUMBER:

  ------------------------------------------- ---------------------------

  -----------------------------------------------------------------------
  NINE‑DIGIT ROUTING TRANSIT NUMBER:

  DEPOSITOR ACCOUNT TITLE:
  -----------------------------------------------------------------------

  ------------------------------------------- ---------------------------
  DEPOSITOR ACCOUNT NUMBER:                   ACH FORMAT:  CCD+  CTX

  ------------------------------------------- ---------------------------

  -----------------------------------------------------------------------
  TYPE OF ACCOUNT:  CHECKING  SAVING  LOCKBOX

  -----------------------------------------------------------------------

+-------------------------------------------+--------------------------+
| SIGNATURE AND TITLE OF AUTHORIZED         | TELEPHONE NUMBER:        |
| OFFICIAL:                                 |                          |
|                                           |                          |
| (Could be same as ACH Coordinator)        |                          |
+-------------------------------------------+--------------------------+

SF 3881 (rev 12/90)

NSN 7540‑01‑274‑9925 3881‑102 Prescribed by Department of Treasury