PAY BY ACH

By submitting this secure form, you authorize Cultivate Collectors Services, dba Amelia Auctions & Appraisals

to debit your bank account for your invoiced amount using the information provided below.

Your privacy and the security and confidentiality of any information that is sent to us is of the utmost importance.

Please note: information sent by standard e-mail is not secure. Do not send personal information such as your password, account numbers, social security numbers, etc. via standard email.

Name and contact information provided below

should match your auction invoice.

Please describe any disparities in the "additional info" field.

First name

Last name

Phone

Zip Code

Additional info:

Invoice No.:

(found in the upper righthand corner of your invoice)

Invoice total to be debited:

(In US dollars)

________________________________________________________________

Bank account type:

Checking Account

Savings Account

Bank Name

Please indicate if this account is:

a personal account

a business account

Bank routing # (9 digits)

Bank account #

Please retype your bank account #

I consent to an ACH withdrawal from the bank account referenced above by Amelia Auctions & Appraisals in the amount indicated. I understand that my purchases may be held for 7 days to ensure the ACH payment clears completely.

amelia

PAY BY ACH

Name and contact information provided below

should match your auction invoice.