Secure Payment Form – KR Electronics, Inc.

If you placed an order by email or fax, you can use this secure form to send you credit card information to us. If you prefer, you may call us at (732) 636-1900 with your credit card details.

Customer Information
KR Electronics Quotation Number*
Customer Purchase Order Number
Contact Name*
First Last
Telephone*
Email Address*
Credit Card Billing Address
Please enter the billing address for the credit card, not the shipping address
Company Name*
Address*
Credit Card Billing Address Line 1 Credit Card Billing Address Line 2 Credit Card Billing City Credit Card State or Province Credit Card Zip Code Credit Card Country
Credit Card Detail
Credit Card
- Visa
- Mastercard
- American Express
Corporate or Government Purchase Card
- Yes
Credit Card Number*
Expiration Date*
CVV Security Code*
Name on Credit Card*
Ship To Address
Address*
Same as Billing Address

Shipping to Address Line 1 Shipping to Address Line 2 Shipping to City Ship to State or Province Shipping to Zip Code Ship to Country
Ship Method*
Bill Shipping Charges to*
UPS or FedEx Account Number
Comments

Customer Information

Credit Card Billing Address

Credit Card Detail

Ship To Address