Please complete this form to participate in the Quick Payment Program.  We will contact you to finalize acceptance.

Company Name

Street Address
City, State ZIP

Mailing Address
(if different)
City, State ZIP
Contact Email Address
Phone Number  

Type of Company 
(check one)
Proprietorship
Partnership
Corporation

FEDERAL TAX I.D. NUMBER

INVOICES DESIGNATED FOR IMMEDIATE PAYMENT:
(CHECK ALL THAT APPLY)
Origin
Linehaul
Destination

PAYMENT OPTIONS

 
Regular mail (no charge)
Overnight ($12.00)
Wire Transfer ($20.00)

HAVE YOU PLEDGED YOUR ACCOUNTS RECEIVABLE AS COLLATERAL?
YES  
NO

If yes, with whom?

By clicking submit, you agree that you have read and accepted the Terms and Conditions of the Quick Pay Program, and choose to become a Quick Pay Partner