Lost/Missing Money Order Refund or Copy Request Form

North American Money Order Company, Inc.
 
Please enter each individual money order number only once!
 
Important Information: If North American Money Order Company's records indicate that the money order has been paid, a copy will be forwarded. If not, a refund will be issued 45 days from the date of purchase and a $25 fee will be deducted from the replacement money order.
 
 Money Order #*
 Amount $*
 

Date Purchased: 
*

 Money Order Status: *
 
 
 
  Money Order #   Amount $
  Money Order #   Amount $

Please Complete This Section with Your Information*

 First Name: 
 Last Name: 
 Address:     
City:     
 State:     
 Zip Code:     
  Phone Number: 
  E-Mail Address:   

Please Make the Refund Payable to: 
 

    I authorize North American Money Order Company to stop payment on this money order. Further, I agree to indemnify and hold North American Money Order Company harmless against any and all payments, loss, damage, expense, and/or liability suffered or incurred by North American Money Order Company by reason of my stop payment authorization. If the original money order returns to my possession, I will return it to North American Money Order Company, Inc. If North American Money Order Company's records indicate that the money order has been paid, a copy will be forwarded. If not, a refund will be issued 45 days from the date of purchase.*

    I understand a stop payment fee of $25.00 will be deducted from my refund amount.*

Please Upload a Scan or Image of the money order stub or written verification from the place of purchase:



If you have any additional documents to upload (i.e. police report for stolen money orders), you can do so here:
If you don't have a police report, please enter the Case Number here: 

**Stop payment are not placed on money orders prior to 45 days from the date of purchase unless a police report and case number are submitted along with the completed claim form and proof of purchase.**

**Incomplete forms will not be processed until all information, including proof of purchase, is received.**
 

Digital signature of this document is considered binding under the Electronic Signatures in Global and National Commerce Act (E-SIGN), 15 U.S.C. 7001

 
* = Required Field
North American Money Order Company
P.O. Box 1208 Alpharetta, GA 30009
P: (800) 736-9212 | F: (770) 360-9490

{{__submission_number__}}