Stay Connected Money Order Deposit Form FOR RESTITUTION & COURT-ORDERED PAYMENTS DID YOU KNOW? HOW TO Money orders can take days to mail and process? SEND A MONEY ORDER 1 2 3 4 Detach and complete the Money Order Deposit Slip at the bottom in blue or black ink. There’s a Better Way Send money without a money order – and get the payment posted the next day!* Make the Money Order payable to JPay. Place the Money Order and the Deposit Slip in an envelope. www.JPay.com Mail to: JPay, PO Box 260130, Hollywood, FL 33026. Sign up for your free account now. Make sure to... JPay Mobile Free mobile app for Android and iPhone. • Write clearly on the form to avoid delays processing the money order 800-574-5729 • Not include any letters or notes with your payment because these will be discarded. Toll-free phone number, 24/7. • Verify that the offender name and DC# are entered correctly on the money order deposit slip. In-person/Cash MoneyGram locations including CVS & Walmart. I n addition to money orders, cashier’s checks and certified bank drafts are also accepted. All procedures, terms and conditions apply. Visit JPay.com for Terms & Conditions. A JPay account is not needed to send Money Orders. Call 866-333-5729 if you need more information or assistance completing this form. Incorporated by Reference in Rule 33-302.110, F.A.C. FLCOPS Form. ✁ * Some facilities do not process on holidays or weekends. ✁ ✁ Money Order Deposit Slip FOR RESTITUTION & COURT-ORDERED PAYMENTS ALL FIELDS REQUIRED Mail to: JPay, PO Box 260130, Hollywood, FL 33026 Your Address Money Order Amount – maximum $999.99 _____________________________________ City __________________________________ Offender’s DC# Offender’s State F L Offender’s Full Name (Last, First) Your First Name (Person Making Payment) Your Last Name (Person Making Payment) DC2-364 (Effective 2/14) State ________________ Zip _____________ Email_________________________________ Your Phone Number (Person Making Payment)