Fillable GPO - Form 4046 Billing Address Code (BAC) Request

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GPO - Form 4046 Billing Address Code (BAC) Request

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The GPO - Form 4046 Billing Address Code (BAC) Request form is 1 page long and contains:

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  • 12 check-boxes
  • 64 other fields

Country of origin: US
File type: PDF

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Form 4046 — Billing Address Code (BAC)
For GPO Use Only
Request a New BAC or Change an Existing BAC
Date received
Note: To establish a Printing and Binding Deposit Account BAC, please use GPO Form 4045.
New BAC
To Establish a New BAC — Select Payment Method
Date BAC
IPAC Billing (Indicate below your agency’s ALC, TAS, and BETC)
established
Non-IPAC Billing ( Check
Credit Card )
Initial and date when
To Change an Existing BAC
customer is notified
Change payment method for BAC
. Select NEW payment method from above.
Deactivate BAC(s): Enter BAC(s) in the additional information box below.
Change ALC from to the ALC indicated below. Also include TAS and BETC.
(Required for IPAC Funding)
Agency Location Code (ALC) Business Event Type Code (BETC)
Treasury Account Symbol (TAS)
Sub-level Allocation Transfer
Agency Beginning Period
Ending Period of Availability Type Main Account Sub-Account
Prefix Code (2) Agency Identifier (3)
Identifier (3) of Availability (4)
Availability (4) Code (1) Code (4) Code (3)
Update: Contact Information (Requestor and/or Finance POC) in the “Additional Information” box list the BAC(s) this update affects.
AGENCY REQUESTOR’S POINT-OF-CONTACT INFORMATION
Name Title
Department or Government Establishment Bureau/Office
Address
City State Zip Code
Phone Ext. Fax Email
AGENCY FINANCE POINT-OF-CONTACT INFORMATION
Name Title
Address
City State Zip Code
Phone Ext. Fax Email
Does your agency require a Line of Accounting to process IPAC transactions for this BAC?
Yes No
(Go to https://www.gpo.gov/docs/default-source/forms-standards-pdf-files/sf-1_instructions.pdf for more information.)
Does your agency require a MIPR to process IPAC transactions for this BAC?
Yes No
Additional Information
I am authorized to complete this GPO Form 4046 and that the information provided is correct and accurate. I acknowledge that I am an authorized representative of my agency
responsible for the above BAC(s).
Authorizing Signature Title Date
Submit completed form to the Commercial Billing Section at requestnewbac@gpo.gov
For questions call 202.512.0197 or email requestnewbac@gpo.gov.
Note: If unable to submit form electronically, fax the completed form to your National Account Manager (NAM) team at 202.312.0171.
GPO Form 4046 R. 08/2017
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GPO - Form 4046 Billing Address Code (BAC) Request

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Completed 26 May 2020

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