Automatic Payment Authorization

Net-terms account · card / bank account on file

Customer Account Information

Complete this form to authorize Green Freight Logistics to keep a payment method on file for approved invoices and freight services. Your payment method will be charged according to the net terms you select, helping avoid checks, missed due dates, and manual payment follow-up. This form takes about 3 minutes to complete. Questions? Contact [email protected] or (512) 354-2647.

Company Name(Required)

Account #

Leave blank if new account — GFL will assign.

Date(Required)

Company Address(Required)

Street Address Address Line 2 City State ZIP Code

Company Phone(Required)

Fax

Primary Contact Name(Required)

Primary Contact Email(Required)

Primary Contact Phone

A/P Contact Name(Required)

A/P Contact Email(Required)

Receipts are sent to the A/P email unless otherwise requested.

A/P Contact Phone

Payment Information

Net Terms(Required)

Due on Receipt

Net 15

Net 30

Payment Type(Required)

ACH (Bank Account)

Credit / Debit Card

Bank Routing Number(Required)

Bank Account Number(Required)

If your bank uses an ACH debit block, authorize Chase/Bluevine/Intuit/QuickBooks Payments as an approved ACH originator so GFL’s debits can post.

Card Number(Required)

Exp. (MM/YY)(Required)

CVV(Required)

Card details are stored with our payment processor (tokenized); GFL does not retain full numbers.

Customer Agreement

By signing, the Customer authorizes Green Freight Logistics, LLC (“GFL”) to keep the payment method above on file and to charge it for the amount of each GFL invoice on or after its due date. Amounts vary by invoice; this is a standing authorization covering all current and future invoices until revoked in writing to [email protected] (revocation must be received at least three business days before a scheduled charge and does not relieve the Customer of amounts already owed). GFL arranges the shipping of freight, parcels, and cargo through appointed motor carriers, acting as a property broker as governed by the U.S. DOT Federal Motor Carrier Safety Administration. Quotes are based on information supplied by the Customer; final rates and services may vary with actual shipment details, so the invoice may differ from any quote. The Customer agrees to pay for all services per the Net Terms above, calculated from the invoice date; late payments may incur additional fees, and in the event of default the Customer is responsible for all costs of collection, including reasonable attorney’s fees. The signer represents that they are authorized to bind the Customer and the account or card provided, and acknowledges review and acceptance of GFL’s Terms and Conditions provided with its rate confirmations. Prices are subject to change without notice.

Printed Name(Required)

Title(Required)

Signature

Signature Date(Required)