Fillable MONEY ORDER RESEARCH REQUEST Western Union Financial Services, (Western Union)

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MONEY ORDER RESEARCH REQUEST Western Union Financial Services, (Western Union)

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The MONEY ORDER RESEARCH REQUEST Western Union Financial Services, (Western Union) form is 2 pages long and contains:

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Page 1
Western Union Financial Services, Inc.
PO Box 7030
Englewood, Colorado 80155-7030
1-800-999-9660
MONEY ORDER RESEARCH REQUEST
This form must be completed by the Purchaser if the original bottom portion/receipt with barcode has been misplaced, lost, or
stolen. A separate form is required for each Money Order.
You must include with this form a $30.00 non-refundable administrative fee (Money Order or check only, payable to Western
Union Financial Services, Inc.). To avoid delays in the research process all supporting documents requested below should be
enclosed if available.
If you are the Purchaser and have your original receipt from the bottom of the Money Order, or the original Money Order, you do
not have to use this form. Please complete and sign the Money Order Tracing/Refund request (located on the back of the
Money Order Receipt).
Money Order Purchaser Information:
Name: _________________________________________ Daytime Phone Number: ( )
Address:____________________________________________________________________________________________
City:___________________________________ State:_________________________________ Zip:_________________
Are you requesting on behalf of a Company? No Yes
If YES,______________________________________________________________________________________________
(Full Legal Company Name)
Money Order Information:
Money Order number (11 digits) if known:
Exact Amount Date of Purchase Time of Purchase
(approximate or exact if known) (approximate or exact if known)
$ / /
Month Day Year
Did you enter the name of the payee on the "Pay to the Order of" line? Yes No
If YES, please provide Payee name________________________________________________________________________
Did you sign your name on the "Purchaser" line? Yes No
Location where Money Order was purchased:
Name of Location/Agent name: _____________________________________Agent number (if known):_______________
Address:____________________________________________________________________________________________
City:___________________________________ State:_____________________ Zip (if known):____________________
Additional information:
Did you purchase this Money Order at the same time as another? Yes No
If YES, (1) Please provide the Money Order Number for each Money Order purchased (if known):
___________________________________________________________________________________________________
(2) Please enclose copies of these Money Orders or copies of their receipts (bottom parts with barcode) if available.
Page 2
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.
Money Order Status: Not Received by Payee Lost Stolen Destroyed
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:
1. Item cashed - You will receive a photocopy (front and back) of the cashed Money Order.
2. Item not cashed - You may receive a refund for the Money Order.
3. 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)
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MONEY ORDER RESEARCH REQUEST Western Union Financial Services, (Western Union)

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Completed 31 January 2021

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