QVTX
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Authorized Collection Transfer
You already hold an authorized amount and want it received and remitted.
Legal / business name
*
Contact name
*
Email
*
Phone
*
Address
Payor / source name
*
Authorized amount (USD)
*
Authorization type
*
Signed authorization / agreement
Court judgment / order
Confirmed/accepted invoice
Settlement already executed
Proof of authorization on file?
Yes - available on request
To follow
Destination for your payout
ACH (US)
Domestic wire
SEPA (EUR)
UK Faster Payments
SWIFT (international)
Reference / notes
$250 engagement + sliding 10% -> 3% by amount. Nothing is charged through this form.
Submit application
We do not ask for, and will not use, contact details of your family, friends or neighbours.