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Credit Card Verification Form

When you place an order with, a Credit Card Verification form may be required if your Billing Address is different from your shipping address to complete your order.

As a Merchant processor, we are required to adhere to strict regulatory guidelines with regards to purchases made with your card not present. This due diligence is to protect our customers and others. It is required that you provide us with the following information listed on the form before we are able to ship your product.

Please click the icon below to download the form. This information must be faxed (315-429-8862) or mailed to our office for your protection.

credit card verification form