PS Form 6401 - Money Order Inquiry

Money Order Inquiry

Money Order Serial No. (As shown on original receipt)

Date on Original Receipt (MM-DD-YYYY)

Money Order Amount

Certication and Signature

I understand that anyone who furnishes false or misleading information on this form may be subject to criminal sanctions (including nes

and imprisonment) and/or civil sanctions (including multiple damages and civil penalties). I agree to repay the Postal Service

™

, upon

demand, the amount of the refund if the designated payee, purchaser, or nancial institution cashes the original money order. The rights and

remedies set forth in 18 U.S.C. 287, 18 U.S.C. 1001, and 31 U.S.C. 3802 shall be incorporated as if fully set forth.

Post Ofce No. (As shown on original receipt)

Purchaser’s First Name (Not for Bank Use)

Bank Use or Post Ofce Only (Bank/Financial Institution Name or Post Ofce)

Mailing Address (For mailing refund, correspondence, or copies)

City

ZIP+4

Telephone No. (Optional) (Include area code)

ABA No. - Bank Use Required

MI Purchaser’s Last Name

Apt. or Suite No.

State

Country (If applicable)

International Telephone No. (If applicable)

Reference No. - Bank or Post Ofce Use Only

Signature of Customer Filing the Money Order Inquiry Date Signed (MM-DD-YYYY)

Privacy Act Statement: Your information will be used to respond to your request. Collection is authorized by 39 U.S.C. 401, 403, and 404; 31 U.S.C. 5318, 5325,

and 5331. Providing the information is voluntary, but if not provided, we may not process your transaction. We do not disclose your information to third parties

without your consent, except to facilitate the transaction, to act on your behalf or request, or as legally required. This includes the following limited circumstances:

to a congressional ofce on your behalf; to nancial entities regarding nancial transaction issues; to a U.S. Postal Service auditor; to entities, including law

enforcement, as required by law including anti-money laundering statutes and regulations, or in legal proceedings; and to contractors and other entities aiding us to

fulll the service (service providers). For more information regarding our privacy policy visit us at usps.com.

POST OFFICE: AFFIX STAMPS

OR METER STRIP HERE

After you le an inquiry, you can check the status by calling our toll-free number 1-866-974-2733.

Mail to: St. Louis Accounting Service Center

General Accounting Branch

PO Box 80453

St. Louis, MO 63180-0453

By presence of this signature, I have veried the customer receipt presented by the purchaser.

Customer’s Photo ID No.

Finance No. of Accepting Ofce

No-Fee Money Order Serial No. (If applicable)

ZIP Code™ Telephone No. (include area code)

ID Type: e.g., Driver’s License or State Issued ID, Military ID, Alien Registration, Passport

Date (MM-DD-YYYY) Amount

Date Inquiry Filed (MM-DD-YYYY)Signature of Postal Service Employee

Post Ofce ID

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PS Form 6401, August 2016 PSN: 7530-02-000-9536 (Page 1 of 2)

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9 9 9

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For Postal Use Only

SECTION A

— Use Black Ink ONLY and Print Within the Boxes.

File an inquiry about a money order any time after purchase as follows: You can get a copy of a cashed money order or request a refund as follows:

 File the inquiry at any Post Ofce.

 Use one form for each money order.

 You must pay a separate fee for each form (i.e., money order inquiry).

 Complete all blocks, sign, and present your customer receipt to the Post Ofce employee. The

employee will verify the information you provide.

 We will issue a refund 60 days or later from the issue date of the money order, or provide a copy of the

money order if it has been cashed.

SECTION B

—

THIS AREA IS FOR OFFICIAL USE ONLY

Instructions for Completing Money Order Inquiry Form

Customer Action:

1. Complete Section A of the form in BLACK ink. Include the date of the original money order in boxes provided. Use ONE form per money

order. Boxes titled Bank Use Only and Bank or Post Ofce Use Only are not required for individual customers. The telephone number

elds are optional.

2. Sign the form and enter the date in the box titled Date Signed.

3. Show your money order customer receipt and personal identication to the sales and service associate at the service window.

Postal Service Employee Action:

1. Request the money order customer receipt and check the serial number, date, Post Ofce number, and amount against the information

on the form. Return the money order customer receipt to the customer.

2. Collect the appropriate fee for the money order inquiry and place a meter strip or stamps in the outlined box.

3. In Section B: Enter the customer identication information (acceptable forms of identication are

driver’s license, state issued ID, military

ID, alien registration card, or passport). Enter the following information for the ofce accepting the PS Form 6401 inquiry form:

10-digit

nance number, telephone number, Post Ofce issue ID, signature of postal employee and date inquiry accepted.

4. If you have elected to issue a no-fee money order to the customer for a damaged or mutilated money order, complete ofce ZIP Code,

serial number, date of issue, and dollar amount from the no-fee money order in Section B. Do not charge an inquiry fee for a no-fee

money order. Write “FEE WAIVED” in the area designated for stamps or meter strip.

5. Sign and date the bottom of the form.

6. Place the original form in an envelope addressed to the St. Louis Accounting Center (address located on front of this form) and mail the

same day. Do NOT retain.

Instructions for Completing Money Order Inquiry Submitted by Banks

Bank Action:

1. Complete Section A of the form in BLACK ink. (You must include your business/organization name and address. Use ONE form per

money order.)

2. The ABA number is required for bank inquiries.

3. Sign the form.

4. Enter the date signed in the boxes provided.

Postal Service Employee Action for Bank Inquiries:

1. Customer photo ID, government issue ID, and customer receipt are not required for bank requests.

2. Include the 10-digit nance number, ZIP Code, and telephone number of the ofce accepting the Money Order Inquiry form.

3. Do not require a fee, this service is provided free of charge.

4. Do not issue a no-fee money order to a bank.

5. Put the original form in an envelope addressed to the St. Louis Accounting Center (address located on front of this form) and mail the

same day. Do NOT retain.

Instructions for Completing Internal Money Order Inquiry Submitted by U.S. Postal Service

Postal Service Employee Action:

1. Complete Section A of the form in BLACK ink. You must include USPS organization name on line titled Bank Use or Post Ofce Use Only

(Bank/Financial Institution Name or Post Ofce), address and date from the

original receipt.

Use ONE form per money order.

2. Sign and date the form.

3. Customer ID, government issue ID, and customer receipt are not required for internal requests.

4. Include the 10-digit nance number (the 10-digit number is your nance number and your 4-digit unit ID), ZIP Code, and telephone

number of the ofce completing the Money Order Inquiry form (only if a no-fee money order is issued).

5. No fee is required for internal requests.

6. Enter Post Ofce Issue ID (this is the ZIP Code plus one digit to signify main ofce or branch).

7. Sign and date the bottom of the form.

8. Put the original form in an envelope addressed to the St. Louis Accounting Center (address located on front of this form) and mail the

same day. Do NOT retain.

9. A scanned image will be provided to your facility if the money order has been cashed.

PS Form 6401, August 2016 (Page 2 of 2)