ACH Form

Payment Information Form

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

Have any questions? Email sell@madisonavenuecouture.com

Your Full Legal Name

Your Email

Your Phone

How Would You Like Us To Contact You?

Bank Information

Bank Name

Account Number

ACH Routing Number

Today’s Date

Approver’s Signature

*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.

Customer Login:

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