U.S. MONEY EXPRESS CO.		NOTE:	This form is used exclusively to send orders
5395 N. Milwaukee Ave., Chicago, IL 60630			to U.S. MONEY EXPRESS CO. and is invalid
			if used as a receipt by any agency.

	ORDER FORM
SPECIFY TYPE OF TRANSACTION
	ZAMOWIENIE


SENDER			AMOUNT OF TRANSFER
Last Name,			AMOUNT :
First Name:
House No.			CHARGES:
and Street:
City, State,			ADDITIONAL FEES:
Zip Code:
Phone No.			RETURN RECEIPT:

Must be filled out by Sender if the amount			TOTAL:
of transfer (including the fees) is $1,000 or more
Date of Birth:
Soc. Sec. #
Sender's ID type & expiration date :
Sender's ID #
Occupation:

RECIPIENT			RECIPIENT'S OPTIONAL INFO
Last Name,			Date of Birth:
First Name:
Street, House No.,			Father's Name:
Apt. No.:
Zip Code, Town			Phone No.:
or Post Office:
Country:


Bank's Name:
Account No.:
Notes:



……………………………..	………………………………………………………..
DATE	SENDER'S SIGNATURE

			SEE NEXT PAGE FOR FURTHER INFORMATION

TERMS AND CONDITIONS

FOR TRANSFER OF FUNDS TO BE REMITTED ABROAD

The transfer will be effected by us subject to the following terms and conditions and we assume no obligation or undertaking except those expressly set forth herein. We shall send, at your risk, a message to our correspondent, requesting that payment be made to the payee in the currency of the place of payment and make funds or credits available therefore.

Payment shall be made at the then buying rate of exchange for cable or mail transfers of our correspondent making the payment, and if the transfer to be effected relative hereto is in U.S. dollars, it shall be payable to the payee subject to regulations and restrictions of the foreign government in connection with foreign exchange transactions.

Any communication relative to the transfer may be in code or cipher. We shall not be responsible for non-performance or loss or damage by reasons of, or resulting from: declared or undeclared war, censorship, blockage, insurrection, civil commotion, any law, decree, regulation, control, or act of any public authority or domestic or foreign government, de jure or de facto, or any agency thereof, whether rightfully or wrongfully exercised; or for any cause beyond our control, all of which are risks assumed by you. U.S. Money Express Co. shall be liable for loss or delay if exclusively within the control of U.S. Money Express Co.

We shall not be obligated to make any refunds unless and until we shall have received from our correspondent confirmation of the effective cancellation of the transfer, and any funds or credits provided by us for payment of the transfer shall have been made freely available to us. No refunds shall be made by us if, because we are furnished with erroneous identification, payment has been made to one other than the payee. You shall be obligated to pay our charges or expenses and those of our correspondents, not previously paid and we may deduct the same from the amount of any refund.

FOR CHECKS

Checks are either issued in the USA for delivery by the sender or issued and delivered to the residence of the beneficiary. In no event shall the seller of this check be responsible for the failure of its correspondents, agents, or subagents, or of the drawee of the check to identify the payee.

The drawer will in no event cancel the check until payment thereon has been effectively stopped and the drawer is in possession of the relative funds and the original check is surrendered to the drawer or, in lieu thereof, as satisfactory bond or indemnity is furnished to the drawer. Nor withstanding anything to the contrary, if a valid demand for refund is made, payment will be made within ninety (90) days of the request.

A refund for an unrealized check will be made in full face value of the draft, however expenses incurred will be borne by the customer unless the check is returned due to non-performance of the correspondent or its agent. The check is not transferable and is not valid after ninety (90) days from the date of its issue, which may differ from the date on which the order is placed.

This form does not constitute an agreement between U.S. Money Express Co. and the customer. A receipt confirming the processing of this order will be issued by U.S. Money Express Co., which will constitute an agreement between you and U.S. Money Express Co. regarding this order, under the conditions stated herein.

If your order is in the amount of $1,000.00 or more, you must give all information requested on the order form.