Fillable Money Order Research Request Form - Western Union (Page 2 of 2) in pdf

Please enclose with this form all available documents showing you are the true purchaser of the requested

Money Order.

This may include, but is not limited to, the original store cash register receipt. If the Money Order was stolen,

please provide a copy of the police report.

 Not Received by Payee

 Lost

 Stolen

 Destroyed

Money Order Status:

Please describe the circumstances of the above: _____________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________

Note: ALL information requested above is required to conduct a search. A search will only be conducted for the data requested.

If there is more than one lost Money Order, please provide the information requested above for each Money Order on a separate

Money Order Research Request form.

Please allow 6-8 weeks for processing this request. You will be notified by mail with one of the following search results:

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

Item not cashed - You may receive a refund for the Money Order.

Item not located by Western Union - Western Union does not guarantee that the Money Order’s serial number can be

located.

In the event the Money Order has not cleared and Western Union is able to locate and verify the information provided by you,

Western Union may issue a refund of the face amount of the Money Order. Western Union reserves the right to deny requests

which are not permissible under applicable law or Western Union policy.

By signing, you represent and warrant that you are the Purchaser of the Money Order described herein and that you have not

cashed, negotiated, deposited, transferred, received payment or received a benefit of any kind, directly or indirectly, from the

Money Order.

By signing, you hereby request and authorize Western Union to issue a stop payment order on the Money Order, provided the

Money Order has not cleared.

If you are requesting on behalf of a Company, by signing you hereby confirm having the power and authority to act on Company’s

behalf and neither the Company, nor any person acting on Company’s behalf, has cashed, negotiated, deposited, transferred,

received payment or received a benefit of any kind, directly or indirectly from the Money Order.

You understand that the $30.00 administrative fee is not refundable.

You agree to indemnify and hold Western Union harmless against any and all damages, costs, expenses and/or liability arising out

of, or otherwise connected with your representations herein including any actions taken by Western Union in reliance upon such

representation, this request, or as a result of the negotiation of the Money Order.

_____________________________________________________

__________________________________

Purchaser Signature (Required):

Date:

Subscribed and sworn to before me this ____________________day of _____________________20_________

My commission expires: ____________________________________

__________________________________________________________

NOTARY PUBLIC

(Notary Stamp, if applicable)

Page 2

Money Order Research Request Form - Western Union Page 2

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