Quickpay Agreement

Select Desired Payment Method(Required)

Carrier Name(Required)

MC #(Required)

Name & Title(Required)

Date

Company Name(Required)

ACH Info

Name on Bank account

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Bank Name

Bank Account Number

Bank Routing number

P2P Info

PayPal Email or ID

Venmo ID

Cash App ID

Zelle Phone # or Email & Recipient’s Name

Phone

DO NOT AUTHORIZE ACH or P2P payments and only mail physical checks to the address above.

E-mail address where payment confirmation is to be sent(Required)

Name & Title(Required)

Global Logistics