Pack Logistics - Request For Payment

Pack Logistics - Request For Payment
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Carrier Name*
Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Carrier Email*
example@example.com
Carrier Invoice Number
Pack Logistics Order Number*
Ex: 100555
Regular Pay - Net 30 days from receipt of invoice and correct paperwork.
Quick Pay - 7% Fee
Advance - Includes any advanced money via comcheck (example: fuel, lumper, etc.)
Do you use a factoring company?*

YesNo
What Type of Payment are you Requesting?*

Regular PayQuick Pay
Did you receive an advance on this load number?*

YesNo
THE AMOUNT TO BE PAID MUST INCLUDE LUMPERS, LAYOVERS, ETC. ANYTHING THAT IS TO BE PAID ON THIS INVOICE IS TO BE INCLUDED IN THE TOTAL AMOUNT TO BE PAID.
Total Amount To Be Paid (only put numbers)*
Ex: 1050.50
Pack Logistics Salesperson on Rate Con*
Upload Complete Paperwork Package in one Document. Please upload PDF document only as we will no longer accept JPEG files beginning March 15, 2021.*

Rate Confirmation / BOL(s) / Lumper Receipt / Delivery Receipt / Any other necessary paperwork
Cancelof
Status
Result
CLICK IF NOT APPROVED
Should be Empty: