Money Order Dearch Form - Moneygram printable pdf download

1550 Utica Ave. So. Suite 100

Mail Station MIN-0023

Minneapolis, MN 55416

Dear Customer:

Please do not use this form if you have your money order serial number.

Because special handling is required for tracing a money order when the serial number is unknown, we must charge for this

service. If you would like us to attempt to locate the money order(s) about which you inquire, we must have the EXACT

Please return this form with $40 processing fee

information requested below. Please allow 90 days for processing.

which is not refundable.

Exact amount of item(s): $ ______________________________________________________

(List each denomination when more than one item was purchased.)

Exact date of purchase (MM/DD/YY): _________/_________/________________________

(Must have exact date of purchase, search will only be completed for the date requested. If more than one date please fill out a separate form

for each)

Name of person or company to whom money order was made out to:

______________________________________________________________________________

What is the name and address of the store/company where you bought your money order?

Name: ________________________________________________Store # _________________

Address: _____________________________________________________

City: _______________________________ State: _________________ Zip code: ___________

Phone Number: (______) _______________________________

Purchaser Information:

Name: ___________________________________________ _____________________________

Address: _____________________________________________________ _________________

City: _______________________________ State: _________________ Zip code: ____________

Your daytime telephone number (include area code): (______) _________________________

Any additional comments:

___________________________________________________________________________________

Please return this form with your payment. You will be notified by mail with one of the following search results:

Item cleared- You will receive a photocopy (front and back) of the cashed item.

Item not cleared- You will receive a refund for the item. Signing below authorizes MoneyGram International to

stop payment on the Money order and you agree to hold MoneyGram International harmless against any and all

expense and/or liability to the negotiation of the Money Order.

Item not located by MoneyGram International

The information that I have provided above is accurate to the best of my knowledge. I understand that MoneyGram

International will attempt to find and provide my serial number and that the non-refundable fee of $40.00 per item is for

research only. MoneyGram International does not guarantee that the serial number will be located.

______________________________________________

_________________________________

Customer Signature

Date

Money Order Dearch Form - Moneygram