Freije & Freije Secure Document Portal

What Type of Information are you Submitting

What Type of Information are you Submitting Banking Information for ACH/Wire Payment Identifcation Insurance Information
Auction Date
Invoice Number
Company Name
Full Name Full Name First Last
Phone Number Phone Number - ### - ### ####
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Email

Confirm Email Address
Bank/Financial Institution Address Bank/Financial Institution Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Bank Phone Bank Phone - ### - ### ####
Account Type

Account Type Checking Savings
Bank 9 Digit Routing
Must be 9 digits. Currently Entered: 0 digits.
Account #
Must be between 8 and 12 digits. Currently Entered: 0 digits.
Account Holder Name as It Appears on Your Statement Account Holder Name as It Appears on Your Statement First Last
Billing Address Billing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
***Please note that we will call to verbally verify the wiring instructions you submit. No wire payment will be processed until we have successfully confirmed the details with you over the phone.***
Insurance Company Name
Insurance Phone Insurance Phone - ### - ### ####
Insured Individuals Name Insured Individuals Name First Last
Policy Number
Expiration
Copy of Insurance Card
Driver's License Information
Name Name First Last
Phone Phone - ### - ### ####
Email

Confirm Email Address
Upload your Driver's License Here
Any Message for Us?
Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Freije & Freije Secure Document Portal

Freije & Freije Secure Document Portal

Driver's License Information