Quick Pay Program (carrier form)
***this form should only be completed if you are interested in receiving Quick Pay, otherwise payment will be made in
accordance of our standard payment terms***
Load # __________________
Date of Load Acceptance:________________
Quick Pay will be issued to the carrier for the amount of the freight invoice by the method requested by
the carrier below upon receipt of the following complete legible documentation: 1) this document, 2)
signed POD’s without loss or damage, and 3) accompanying receipts of approved related charges.
Incomplete or illegible documentation may delay payment to the carrier. Payments are made during
regular business hours M-F only, except holidays. The fee charged for the Quick Pay service is in relation
to the timing of the Quick Pay requested, as follows:
CHOOSE ONE PAYMENT SCHEDULE:
____ Next Day Program allows carrier to be paid the next day after receipt of required documents
prior to 12:00 PM (noon) CST. The service fee for next day service is 5% of the gross payout.
____ Five Day Program allows carrier to be paid the 5th day after receipt of required documents prior
to 12:00 PM (noon) CST. The service fee for five day service is 4% of the gross payout.
____ 14 Day Program allows carrier to be paid the 14th day after receipt of required documents prior
to 12:00 PM (noon) CST. The service fee for fourteen day service is 3% of the gross payout.
CHOOSE ONE METHOD OF PAYMENT:
____ Direct Deposit (voided check or routing and account# required)
Routing # ________________________
Acct # _______________________
____ Comchek
____ Transcheck
By filling out and signing below, I agree to this Quick Pay program and authorize the associated fees to
be deducted. I confirm that I am not using a factor company (or my factor company will authorize a
release for this transaction). Quick Pay payments may be suspended to any carrier upon notification that
the carrier is under a factoring agreement applicable to this load. Complete terms and conditions can be
found at www.brokerfactor.com/terms and are incorporated herein by reference.
Agreed to and accepted this _______ day of ________________________, 20___.
Carrier Name: _______________________________________________M/C #___________________
Street Address: ______________________________________________________________________
City: _______________________________________________ State: _____ Zip: ________________
Phone: ________________________________ Fax or email: _________________________________
Existing Factor: _____________________________________________________________________
Authorized Signer: ________________________________________________ Title: _________________
Print Name:____________________________________________________________________________
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Quick Pay Repayment Agreement (broker form)
***this form must be completed by the broker when your carrier chooses to receive XFactors Quick Pay***
Agreement between XFactors Financial and Freight Broker for this Individual Load
Load # __________________
Date of Load Acceptance:___________________
Carrier provides signed Quick Pay Program (carrier form) document to Broker authorizing Quick Pay
from XFactors Financial to authorized carrier for this freight load only directly to carrier. Broker agrees to
confirm accepted delivery without loss or damage with shipper (or whoever is paying broker). Broker
agrees that the following complete legible documentation will be provided to XFactors Financial prior to
payment by Quick Pay Program: 1) this document, 2) signed POD’s without loss or damage, 3)
accompanying receipts of approved related charges, and 4) signed copy of broker/carrier agreement.
Incomplete or illegible documentation may delay payment to the carrier. Broker is not permitted to
receive Quick Pay funds for this load under any circumstances. Broker will invoice Shipper directly.
Broker shall pay XFactors Financial directly in accordance with the payment schedule selected below:
CHOOSE ONE PAYMENT SCHEDULE:
____ Gross Payout (minus 1%) to be paid to XFactors WITHIN 21 days of XFactors paying carrier.
____
Gross Payout to be paid to XFactors WITHIN 40 days of XFactors paying carrier.
____
Gross Payout (plus 1%) to be paid to XFactors WITHIN 50 days of XFactors paying carrier.
No offsets, short pays, or any type of claims permitted. Broker GUARANTEES payment to
XFactors Financial.
Fill out attached spreadsheet and fill in final amounts below:
*Amount requested of XFactors to pay carrier: $__________Date to be paid: ___________
*Amount broker will pay XFactors $____________ Date to pay: ______________
(This is the amount and date broker agrees to pay XFactors Financial. XFactors will
invoice broker.)
By filling out and signing below, I agree to this Quick Pay program and authorize the associated fees to
be charged. XFactors reserves the right to suspend Quick Pay payments to any carrier upon notification
that the broker has a factoring agreement applicable to this load. Complete terms and conditions can be
found at www.brokerfactor.com/terms, which terms are incorporated herein.
Agreed to and accepted this _________ day of ___________________________, 20___.
Broker Name: _____________________________________________M/C #___________________
Street Address: ____________________________________________________________________
City: _____________________________________________ State: _____ Zip: _________________
Phone: ___________________________________ Fax: ___________________________________
Authorized Signer: ________________________________________________ Title: _______________
Print Name: __________________________________ email: _______________________________
Fax all Documents to: (816) 220-1766
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XFactors Financial Quick Pay Funding
Spreadsheet
Broker - please fill this out and fax with other requested documents
CARRIER PAY INFO
Gross Amount of Carrier Pay
Add Additional Pay (fees, etc)
Subtract Advances Broker Paid to Carrier (and any other subtractions)
Net Amount Broker Owes Carrier
Amount Broker is requesting XFactors to pay Carrier (* copy to broker
form)
BROKER PAYMENT INFO
Net Amount Broker Owes XFactors (same as "Net Amount Broker Owes
Carrier" above)
Add/Subtract fee for Broker Payment Schedule (-1%, 0%, +1%)
Amount XFactors will invoice Broker (*copy to broker form)
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