Electric Motor Warehouse
Fax/Mail Order Form
Fax to 1-810-744-1424

We understand a lot of people are unsure or uneasy about submitting their credit card information online.  If you are unsure or don't feel safe ordering online, simply print this order form to your printer. Then simply return to our web site, take your time and browse our catalog pages.  When you find the items you want, write them on the order form, fill in your shipping and credit card information, and either fax it, call us or mail it to us.

Upon receipt of your fax/mail order, we will process your order and e-mail you your order status.  We will also advise you of your shipping costs.

Name:________________________________________ Day Time Phone #____________________

Address:______________________________________ Fax #______________________________

City:_____________________________ State: ___________________Zip Code:_______________

Country:_______________________ Postal Code (if any):_________________

Credit Card #_______________________________________________Expires________________ C V V (3 digit code)__________________
            Visa(  )  MasterCard(  )  American Express (  )  Discover Card(  )

E-mail address:___________________________________________

Ship to if different from above:

Name:___________________________________

Address:_________________________________

City:_____________________ State:_____________ Zip Code:______________

Fax Order To: 1-810-744-1424
or call us at 1-877-98-MOTOR 
Or Mail To: Electric Motor Warehouse            
                    G 1460 E. Hemphill
                    Burton, MI  48529-1202