Request Money Order Refund

FIDELITY EXPRESS

MONEY ORDER PHOTOCOPY/REFUND REQUEST
Instructions
1. Purchaser shall complete this form below and print it using the browser's print option.  Sign the form and mail to Fidelity Express with the original purchaser's receipt.  Make copies for your records.
2. A stop payment is placed on the original money order within 2 business days of receipt of all required paperwork by this office.
3. Enclose a separate form per request.  A $20.00 processing  fee* per request will be deducted from your refund.
*This non-refundable processing fee is subject to change without prior notice.
4.  Incomplete or ineligible forms could delay your request.  Please allow up to 30 days for processing.
*If your money order has cashed no refund is available.

CAUTION: If you do not have the original money order or purchaser's receipt please call 1-800-621-8030 ext. 7020.

Instructions for copy: For copies less than 1 year old please fill out a separate form and enclose a $10.00 processing fee* for each request.  For copies over 1 year old please enclose a $20.00 processing fee* for each request.
*This non-refundable processing fee is subject to change without prior notice.
Please fill out the information below and print it using the browser's print option. Sign the form, enclose a check or money order for the proper fee, enclose the documentation, and mail to:
Fidelity Express
P.O. Box 768
Sulphur Springs, Texas 75483.
Check Appropriate Boxes:    Refund Photocopy
Money Order Information
Amount: $
Number: 
Store
Purchased From:
Date Purchased:
Payable To:
Purpose:
Address:
City:
State:
Zip:
Your Name:
Employed by:
Your Address:
Your City:
State:
Zip:
Home Phone:
Work Phone:
Ext:
Note: Please Print, Sign, and Mail this form. We must
have an original signature.
 
  I hereby authorize Fidelity Express and/or agents of this company to verify my claim and I authorize an immediate stop payment, holding harmless and further indemnifying Fidelity Express and/or its agents against any action, payments, loss, damages, liability, or expense as a result of this claim.  
  Purchaser Sign Here in Ink:_____________________________________  
  **Once we have identifying information regarding the purchaser of this money order we can only speak to the purchaser.