This form is required for first time customers using credit card payments over the phone.

Due to the increased volume of attempted fraudulent credit card users we have created this form to ease the process of authenticating credit cards being processed. We apologize for the extra steps but in the long run this is for everyone’s benefit.

Please note:

  • **Please be aware there is a 5% convenience fee of the entire order for all AMEX transactions**
  • **CC WILL REMAIN ON FILE IF COLLECT SHIPPING IS USED**
  • If you have any questions you may contact our Credit Card Processing department at (302)‐653‐1844 ext. 111 or by email at emwccr@electricmotorwholesale.com
XXX-XXX-XXXX + Ext
Provide a clear image of the front of your credit card
Provide a clear picture of the 3 or 4 digit code from the back of your credit card
3 or 4 digit code from the back of your credit card
If you have placed an order that is shipping to a different address than stated above billing address, you must approve to complete transaction.