Professional Documents
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ENVIAR DINERO
GOLD CARD
RELOAD PREPAID
RECARGAR PREPAGO
OR
COMPLETE
FORM
TAKE TO
COUNTER
COMPLETA EL FORMULARIO
WESTERNUNION.COM/GOLDCARD
LLVALO AL MOSTRADOR
1-800-325-6000
WESTERNUNION.COM
COMPLETE
FORM
COMPLETA EL
FORMULARIO
1. IN ADDITION TO THE TRANSFER FEE, WESTERN UNION ALSO MAKES MONEY WHEN
IT CHANGES YOUR DOLLARS INTO FOREIGN CURRENCY. PLEASE SEE ATTACHED PAGES
FOR MORE INFORMATION REGARDING CURRENCY EXCHANGE. IF THE EXCHANGE RATE
FOR YOUR TRANSACTION WAS DETERMINED AT THE TIME YOU SENT THE MONEY, THE
CURRENCY TO BE PAID OUT AND THE EXCHANGE RATE ARE LISTED ON YOUR RECEIPT.
OTHERWISE, THE EXCHANGE RATE WILL BE SET WHEN THE RECEIVER RECEIVES THE FUNDS.
When sending $1000 or more, You must provide identification and additional information.
Limits: Mobile Money ($1500 per day, $5000 per month) and to Mexico (maximum send of $7500)
2. By completing, you authorize us to send you text message notification(s) about your money
transfer status, including notifying you when the receiver picks up funds. Standard message
and data rates may apply.
3. Money Transfer to a Bank Account is available to select countries, including the USA,
Mexico and Brazil. Please check with the Agent to inquire about availability to other countries.
4. Money Transfer to a Mobile Phone is available to select countries and mobile operators.
Available at participating agents. For additional information please visit www.westernunion.com.
TAKE TO
COUNTER
LLVALO AL
MOSTRADOR
AGENT COPY
START HERE
YOUR INFORMATION
First Name(s)
Last Name(s)
City
Phone/Loyalty#
State
Zip
SEND / RECEIVE
MONEY
I WANT TO:
TEXTME
SEND MONEY
Your Mobile
SEND / RECEIVE
MONEY
PAY
BILLS
PAY
BILLS
AMOUNT
First Name(s)
TO
PAY A BILL
PAY
BILLS
PAY
BILLS
RELOAD CARDS /
MOBILE PHONES
RELOAD CARDS
MOBILE PHONE
MOBILE PHONES
RELOAD CARDS /
MOBILE PHONES
BUY
PREPAID CARDS
BUY
PREPAID CARDS
BUY
PREPAID CARDS
BUY
PREPAID CARDS
Attention (if applicable)
BUY
MONEY ORDERS
BUY
MONEY ORDERS
BUY
MONEY ORDERS
BUY
MONEY ORDERS
Destination: Country/State
RECEIVER
I WANT TO:
SEND / RECEIVE
MONEY
SEND / RECEIVE
MONEY
Account Number
AMOUNT
Amount (Dollars) 1
Last Name(s)
SPEED
SELECT ONE:
Urgent
CASH PICKUP
SPEED
Next Day
2nd Day
Money in Minutes
SEND / RECEIVE
MONEY
PAY
BILLS
TEST QUESTION
I WANT TO:
INFO
OR:
RELOAD PREPAID
RELOAD CARDS /
MOBILE PHONES
BUY
PREPAID CARDS
RELOAD PREPAID CARDS
/
MOBILE PHONES / OTHER
BUY ACCOUNTS
MONEY ORDERS
Card number, account number, order number, telephone number or user name.
Bank Name
Routing / BIC / IFSC
AMOUNT
Amount (Dollars) 1
Other information
OR:
SIGN HERE
Your
Signature
Certain terms and conditions governing this transaction and the services
you have selected are set forth on the attached pages. By signing this
receipt, you are agreeing to those terms and conditions.
XXXX
COMENZAR AQU
TU INFORMACIN
Nombre(s)
Apellido(s)
Ciudad
Correo Electrnico
Telfono
Estado
Cdigo Postal
SEND / RECEIVE
MONEY
QUIERO:
QUIERO:
ENVIAR DINERO
Monto A Enviar (Dlares)1
RELOAD CARDS /
MOBILE PHONES
RELOAD CARDS /
MOBILE PHONES
BUY
PREPAID CARDS
BUY
PREPAID CAR
BUY
PREPAID CARDSA La Atencin De (Si Corresponde)
BUY
MONEY ORDERS
BUY
MONEY ORDE
BUY
Destino
Ciudad/EstadoPREPAID CARDS
BUY
MONEY ORDERS
BUY
MONEY ORDERS
MONTO
Monto (Dlares) 1
Apellido(s)
VELOCIDAD
VELOCIDAD
Giro Paisano
PREGUNTA DE PRUEBA
Urgente
Da Siguiente
2do Da
PUEDE QUE LAS OPCIONES NO ESTN DISPONIBLES PARA TODOS LOS PAGOS
Gino Telegrafico
Dinero en Minutos
QUIERO:
SEND / RECEIVE
MONEY
SEND / REC
MONEY
PAY
BILLS
PAY
BILLS
RECARGAR PREPAGO(A)
Respuesta De Prueba
INFORMACIN
RELOAD CARDS /
MOBILE PHONES
RELOAD CA
MOBILE PH
BUY
BUY
PREPAID CA
PREPAID CARDS
RECARGAR TARJETAS
PREPAGAS/
TELFONOS CELULARES/OTRAS
CUENTAS
BUY
MONEY ORDERS
MONTO
Informacin Adicional
O:
ELIGE UNO:
RECOGER EFECTIVO
O:
RELOAD CAR
MOBILE PHO
PAY
BILLS
Nombre(s)
RELOAD CARDS /
MOBILE PHONES
PAY
BILLS
MONTO
DESTINATARIO
PAY
BILLS
SEND / RECEIVE
MONEY
Tu Celular
SEND / RECEIVE
MONEY
TEXTAME
SEND / RECEI
MONEY
Monto (Dlares) 1
FIRMA AQU
Tu
Firma
AGENT USE ONLY
Amount
$
Other Fee
$
Tax
$
Total Collected
$
Date
$
Amount
$
Agent Signature
BUY
MONEY ORD
RESOLUTION OF DISPUTES
Unless You opt out as set forth below, any dispute arising from or relating to this
transaction shall be resolved by final and binding arbitration. The arbitrator shall
also decide what is subject to arbitration. The arbitration will be administered by
National Arbitration and Mediation (NAM) under its Comprehensive Dispute
Resolution Rules and Procedures, which are available at www.namadr.com/
downloads.cfm or by writing to 990 Stewart Ave., 1st Fl., Garden City, NY, 11530
and explain how to initiate arbitration. You will be responsible for up to $125 of
the administration fees. Western Union may reduce this amount if you
demonstrate hardship. This agreement is governed by the Federal Arbitration
Act, and any award shall be subject to judicial confirmation. Any arbitration shall
take place on an individual basis; class actions or arbitrations are not permitted.
If any part of this paragraph is deemed invalid, it shall not invalidate the other
parts. If NAM is unavailable, the parties or a court will select another arbitrator.
You may opt out of arbitration within 30 days after initiating a transaction by
calling 1-800-325-6000 (WU). IF YOU DO NOT OPT OUT, YOU WILL WAIVE ANY WESTERN UNION PRIVACY POLICIES
RIGHT TO A TRIAL BY JURY OR JUDGE IN COURT AND ANY RIGHT TO Western Union may disclose Your personal information to third parties as
PARTICIPATE IN A CLASS ACTION.
explained in the Western Union Privacy Statement (WU); to obtain a copy, ask
Your Agent, visit www.westernunion.com (WU), or call 1-800-562-2598 (WU).
LIMITATIONS OF LIABILITY
Information disclosed may include Your financial background, Your contact
IN NO EVENT SHALL WESTERN UNION BE LIABLE FOR DAMAGES WHETHER information, Your identification, information about Your transactions with us and
CAUSED BY NEGLIGENCE ON THE PART OF ITS EMPLOYEES, SUPPLIERS OR other information relating to financial matters. Recipients may include financial
AGENTS OR OTHERWISE, BEYOND THE SUM OF $500 (in addition to refunding institutions, retailers, our service providers, government agencies and direct
the transaction amount and the transfer fee and except as provided in California marketers. You may direct us to limit certain disclosures of Your information to
Financial Code 2102(c)), UNLESS YOU HAVE OBTAINED A HIGHER LIABILITY some of these parties. Your choice to limit certain disclosures will apply until You
LIMIT BY CALLING THE CUSTOMER SERVICE NUMBER ABOVE AND PAYING tell us to change Your choice or we delete Your data from our systems. To limit
AN ADDITIONAL FEE. IN NO EVENT SHALL WESTERN UNION OR ITS AGENTS disclosures of Your information (opt out), call 1-800-562-2598 (WU).
BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL,
CONSUMER FRAUD ALERT: PROTECT YOURSELF. BE CAREFUL WHEN A
EXEMPLARY OR PUNITIVE DAMAGES, OR THE LIKE.
STRANGER ASKS YOU TO SEND MONEY, ESPECIALLY FOR INTERNET
CURRENCY EXCHANGE, INTERNATIONAL SERVICES
AUCTIONS, NEWSPAPER OR TELEPHONE OFFERS
In addition to the transfer fees applicable to this transaction, a currency Western Union does not guarantee delivery or suitability of goods or services paid
exchange rate will be applied. United States currency is converted to foreign for with Services. Western Union is not an escrow service provider. Customer and
currency at an exchange rate set by Western Union unless the laws of the Receiver agree not to use Services for escrow purposes.
Expected Payout Location do not permit Western Union to set an exchange
rate. Any difference between the rate given to You and the rate received by LOS SERVICIOS DE TRANSFERENCIA DE DINERO WESTERN UNION
Western Union will be kept by Western Union (and its Agents in some cases) (SERVICIOS) SON PROPORCIONADOS POR WESTERN UNION FINANCIAL
in addition to the transfer fees. Subject to applicable law, the actual or
estimated currency exchange rate applicable to Your transaction will be SERVICES, INC. (WESTERN UNION) Y SE PRESTAN SUJETOS A LOS
provided to You on the written disclosures provided to You by Western Union SIGUIENTES TRMINOS Y CONDICIONES (ACUERDO) Y A LAS LEYES
in connection with Your transaction. Payouts will generally be made in the CORRESPONDIENTES.
national currency of the Expected Payout Location (Local Currency). In Se puede obtener informacin adicional acerca de los Servicios en www.
some countries, You may designate a payout currency other than the Local westernunion.com, o preguntndole a su Agente de Western Union
Currency; however, the alternate currency You choose may not be available at (Agente). La disponibilidad de los Servicios depende de ciertas condiciones
all Agent locations. Western Union is not responsible for the currency incluyendo el Servicio seleccionado (incluyendo trminos especiales
exchange rate that will be applied if Receiver chooses to receive a currency aplicables a cada Servicio), la cantidad enviada, el pas de destino del dinero,
other than the currency You selected.
la disponibilidad de moneda, los reglamentos y las normas que correspondan,
requisitos en cuanto a documentos de identificacin, el horario de
SPECIAL TERMS FOR TRANSFERS TO BANK ACCOUNTS, CARDS, OR los
atencin del sitio (factores que se denominan, en su conjunto, las
MOBILE WALLETS
Restricciones). El destinatario designado (Destinatario) puede recibir los
Where available, Western Union may allow You to credit the bank account fondos enviados por un Cliente de Western Union (Usted) en una localidad
(Bank Account), prepaid or credit card (Cards), mobile wallet (MWallet) de Agente de Pago Designada por Usted. Para transacciones enviadas
or similar account of Receiver (collectively, Accounts). The Account dentro de los EE.UU., localidad de Agente de Pago Designada significa
provider may impose additional fees on Receiver for receiving the funds into cualquier localidad de Agente en el Estado de destino identificado por Usted,
an Account. Unless required by applicable law, Western Union accepts no o en un Estado vecino. Para transacciones enviadas fuera de los EE.UU.,
responsibility to You nor to any Account holder, for any fees imposed on localidad de Agente de Pago Designada significa cualquier localidad de
Receiver by the Account provider. If the currency You select to send to an Agente en el pas de destino identificado por Usted. El Destinatario
Account is not the currency in which the Account is denominated, the normalmente recibir el dinero enviado por Usted en efectivo, en cheque o en
Account provider may convert the funds at its own currency exchange rate una combinacin de las dos formas; en el caso de algunos Servicios, el dinero
or reject the transfer. Receivers agreement with the Account provider puede ser acreditado a un banco, tarjeta prepagada, cuenta de mWallet o
governs Receivers rights, liabilities and fees (including fees to transfer cash cuenta similar. En las algunas circunstancias, el Destinatario puede elegir un
out of a Card or MWallet), and the Account provider may impose its own mtodo de pago que difiere del mtodo de pago especificado por Usted;
restrictions regarding funds availability, limits that may be transferred to or Usted autoriza a Western Union a honrar la eleccin de mtodo de pago del
held in Accounts, hours of operations, holidays or other limitations. In most Destinatario. Los Destinatarios que reciban pagos por un medio diferente a
cases, Receiver must be enrolled in a Card or MWallet program in order to efectivo podran incurrir en cargos adicionales para retirar sus fondos. Para
receive a transfer. A Receiver who is not enrolled in a Card or MWallet el servicio de Pago de Facturas de Western Union, Western Union enva los
program may be able to receive funds at an Agent location and may be fondos de Usted a una compaa que acepta LOS SERVICIOS DE
subject to additional requirements. Western Union may make money from TRANSFERENCIA DE DINERO WESTERN UNION (SERVICIOS) SON
fees associated with use of a Card or MWallet. Neither Western Union, nor its PROPORCIONADOS POR WESTERN UNION FINANCIAL SERVICES, INC.
Agents, endorse or recommend the services of any Card or MWallet provider. (WESTERN UNION) Y SE PRESTAN SUJETOS A LOS SIGUIENTES TRMINOS
IMPORTANT NOTICE FOR TRANSFERS TO BANK ACCOUNTS: PLEASE Y CONDICIONES (ACUERDO) Y A LAS LEYES CORRESPONDIENTES.
MAKE SURE THE ACCOUNT NUMBER, BANK DETAILS, AND CURRENCY Se puede obtener informacin adicional acerca de los Servicios en www.
SELECTED ARE CORRECT BEFORE SENDING. IF THE ACCOUNT NUMBER OR westernunion.com. La disponibilidad de los Servicios depende de ciertas condiciones
BANK DETAILS ARE INCORRECT, MONEY MAY BE SENT TO THE WRONG incluyendo el Servicio seleccionado (incluyendo trminos especiales aplicables a
BANK ACCOUNT AND MAY NOT BE RECOVERED. IMPORTANT NOTICE FOR cada Servicio), la cantidad enviada, el pas de destino del dinero, la disponibilidad de
moneda, los reglamentos y las normas que correspondan, los requisitos en cuanto a
documentos de identificacin, el horario de atencin de las localidades de Agentes
(factores que se denominan, en su conjunto, las Restricciones). El destinatario
designado (Beneficiario) puede recibir los fondos enviados por un cliente de
Western Union (Usted) en una Localidad de Agente de Pago en la Localidad de
Pago Esperada. Para transacciones enviadas dentro de los EE.UU., localidad de
Agente de Pago Designada significa cualquier localidad de Agente en el Estado de
destino o territorio identificado por Usted. Para transacciones enviadas fuera de los
EE.UU., localidad de Agente de Pago Designada significa cualquier localidad de
Agente en el pas de destino identificado por Usted. Los servicios que ofrecen
Telecomunicaciones de Mxico (Telecomm) solo estn disponibles en localidades
Telecomm. El Beneficiario normalmente recibir el dinero enviado por Usted en
efectivo, en cheque o en una combinacin de las dos formas; en el caso de algunos
Servicios, el dinero puede ser acreditado a un banco, tarjeta prepagada o tarjeta de
crdito, cuenta de telefona mvil (MWallet) o cuenta similar. El Beneficiario puede
elegir un mtodo de pago que difiera del mtodo de pago especificado por Usted;
Usted autoriza a Western Union a honrar la eleccin de mtodo de pago del
Beneficiario. Los Beneficiarios que elijan recibir pagos por un medio diferente a
efectivo o en alguna otra moneda distinta a la elegida por usted podran incurrir en
cargos adicionales para retirar sus fondos. Algunos pases y/o jurisdicciones pueden
imponer un impuesto, cargo y/o tarifa cuando el Beneficiario reciba o acceda al dinero
transferido. Las Transacciones: (i) que sobrepasen ciertas cantidades; (ii) a ciertos
destinos; (iii) que impliquen ciertos asuntos regulatorios o asuntos de proteccin al
consumidor; o (iv) que sean enviadas con opciones de retraso, pueden demorar ms,
estar sujetas a lmites en dlares o estar sujetas a Restricciones adicionales. Las
Transacciones pueden ser reportadas a las autoridades competentes. El envo de
mensajes o los servicios de notificacin pueden incluirse como costos adicionales. En
algunos destinos, se le puede exigir al beneficiario que presente una identificacin,
responda una pregunta de prueba o ambos para recibir los fondos en efectivo. Las
preguntas de prueba no son una caracterstica de seguridad adicional y no se puede
utilizar para retrasar el pago de una transaccin y estn prohibidas en ciertos pases.
WESTERN UNION CONFA EN LA INFORMACIN QUE USTED PROPORCIONA
PARA ENVIAR DINERO. REVISE QUE TODOS LOS DETALLES DE TRANSACCIN
SEAN EXACTOS ANTES DE CONTINUAR.
CARGO POR ADMINISTRACIN
Si una transferencia de dinero no es reclamada o cancelada por Usted dentro de
un ao a partir de la fecha en que haya sido enviada se cobrar un cargo por
administracin no reembolsable hasta de cincuenta centavos mensuales
contados a partir de la fecha en que la transferencia de dinero fue enviada, pero
no podr exceder en total cuarenta y dos dlares, que sern deducidos del monto
principal de la transferencia (o bien, en los lugares en los que el recargo exceda
del permitido por la ley, el mximo que la ley permita).
REEMBOLSOS