mts_precious_metals_pmt_request_form.doc | |
File Size: | 27 kb |
File Type: | doc |
Click above to download
MTS Precious Metals
Payment Request Form
Name: ________________________________________________________________________
Address: ________________________________________________________________________ Street House, Apt, Unit #
________________________________________________________________________
City State Zip Code
Email:__________________________________________________________________
Phone: Daytime__________________________________Evening________________________
Instructions: ________________________________________________________________________
Briefly describe the contents of the package (ie. 2 rings, 1 chain, etc.)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Please check the appropriate box and fill in information if required.
____PayPal: _________________________________________________________
Account E-mail
____Western Union: ___________________________________________________
WU branch location
____Money Gram: _____________________________________________________
MG branch location
____Check by Mail: ____________________________________________________
Legal Name & Address if different from stated above
____Direct Deposit: _____________________________________________________
Routing Number
______________________________________
Account Number
______________________________________
Name of the Banking Institution, branch location
______________________________________
Legal Name on the Account
I, the undersigned, hereby state that I am over the age of eighteen (18) years old. I further state that I understand the Terms and Conditions of the service and am a legal resident of the United States. I declare full ownership of the enclosed property and state full authority to resell said property.
Signature ______________________ Date of Birth ____/____/______
Date ______/______/_________Pin Code ___________
Payment Request Form
Name: ________________________________________________________________________
Address: ________________________________________________________________________ Street House, Apt, Unit #
________________________________________________________________________
City State Zip Code
Email:__________________________________________________________________
Phone: Daytime__________________________________Evening________________________
Instructions: ________________________________________________________________________
Briefly describe the contents of the package (ie. 2 rings, 1 chain, etc.)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Please check the appropriate box and fill in information if required.
____PayPal: _________________________________________________________
Account E-mail
____Western Union: ___________________________________________________
WU branch location
____Money Gram: _____________________________________________________
MG branch location
____Check by Mail: ____________________________________________________
Legal Name & Address if different from stated above
____Direct Deposit: _____________________________________________________
Routing Number
______________________________________
Account Number
______________________________________
Name of the Banking Institution, branch location
______________________________________
Legal Name on the Account
I, the undersigned, hereby state that I am over the age of eighteen (18) years old. I further state that I understand the Terms and Conditions of the service and am a legal resident of the United States. I declare full ownership of the enclosed property and state full authority to resell said property.
Signature ______________________ Date of Birth ____/____/______
Date ______/______/_________Pin Code ___________