DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
AUTOMATED CLEARINGHOUSE CREDIT ENROLLMENT
19 CFR 24.26
Please type or print information
Mark one:
New Enrollee
Change of Information
Date:
Payer Company Name:
Payer Company Address:
Payer Contact Name(s):
Payer Phone Number(s):
Fax:
Payer Identification Number:
(Importer, Social Security or CBP Assigned Number)
(3 Character Broker ID)
(This form will be used to maintain point of contact information)
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:
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
Filer Code:
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)
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: ACH-Customs@cbp.dhs.gov
Payer Email Address: