Auction House ACH Payment Authorization Form
Authorize an ACH payment for an auction invoice or purchase.
Customer full name
*
First Name
Last Name
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Auction invoice or lot reference
*
Authorized payment amount
*
Debit frequency
*
Please Select
One-time payment
Recurring payment
Payment start date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Electronic signature
*
Signature date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Authorization
Submit Authorization
Should be Empty: