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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
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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.
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* Some facilities do not process on holidays or weekends.
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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)