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Welcome
Credit Application
Product Registration
Menu
Welcome
Credit Application
Product Registration
Credit Card Payment Authorization Form
I hereby authorize Wholesale Electric Caribe Inc. to charge the following Credit Card for fees as
indicated below:
Authorization Type
One Time Pay
Future Orders
I hereby authorize Wholesale Electric Caribe, Inc. to deduct funds from my credit card. I certify that I am the cardholder and I understand that once these funds are deducted from my account, they are non-refundable. This is only an authorization not an official payment. The sales person will send a Pay2Link through e-mail or phone number provided in the form to complete the payment process
Order Information
Order Number:
*
Amount to Pay:
*
$
Card Owner Information
Name
*
Last Names
*
Phone Number
*
E-Mail
*
Billing Address
*
Billing Address
Billing Address
Billing Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
ID Front
*
License or Passport
Choose File
Maximum file size: 8.39MB
ID Back
*
License or Passport
Choose File
Maximum file size: 8.39MB
If you are human, leave this field blank.
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