PREPAYMENT / FUEL ADVANCE- ACH /Wire
Freight Broker
*
Please Select
Selmy G.
Alfredo M.
Angel N.
Angel R.
Shipment ID / BOL#
*
BOL (Must include Carrier Name & MC#)
*
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Cancel
of
RATE CONFIRMATION
*
Browse Files
Cancel
of
VOIDED CHECK OR BANK VALIDATION
Browse Files
Not required but recommended to ensure timely payment
Cancel
of
Pick Up Date
*
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Month
-
Day
Year
Required Delivery Date
*
-
Month
-
Day
Year
CARRIER NAME
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MC#
*
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Bank
*
Account Holder Name
*
9-Digit Routing Number
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Account Number
*
FOR INTERNATIONAL ACCOUNTS: SWIFT CODE REQUIRED
SWIFT CODE
For Wires - Account Holder Address is Required
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Account:
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Personal
Business
Other
FUEL ADVANCE
*
*Will be verified*
Payment Type
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Standard Ach (free)
Wire ($25 Fee)
Same Day ACH (1% Fee)
I understand that payments are subject to review by either sender or receiver's bank.
*
Accepted
I understand that the standard processing hours for FWD Freight are 10 AM EST - 7 PM EST Monday - Friday. I understand and accept that most payments are able to be processed same day, however, processing may fall on the next business day. Payment status can be inquired by emailing AP@fwd-freight.com.
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Accepted
I understand that missing documentation or inaccurate information may delay payments and/or cause a return in payments. I have hereby verify that I have reviewed the form for accuracy and accept any return/reprocessing fees for incomplete or inaccurate information provided.
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Accepted
Form Completed By:
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First Name
Last Name
Title
*
Date
*
-
Month
-
Day
Year
Submit
Should be Empty: