Payment Information Form

This form is used for ACH payments and is required for all “Sellers” and “Consignors”.
eSignatures are accepted.

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Bank Information
*Please note, this form is for domestic U.S. ACH electronic transactions. By signing the agreement above, you authorize Madison Avenue Couture Inc. to electronically deposit the net pay to the above specified account.
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purchase information
Due to the high value of this purchase, please contact one of our client associates to arrange payment & delivery
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1 (888) 623-2832
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