Quick Pay Form

Instructions to our customers on how to send a Quick Pay^SM

With the Western Union® Quick Pay^SM service you'll be able to send us urgent payments electronically. Western Union Quick Pay allows you to send your payment to us directly. Simply bring your cash payment in local currency – where applicable - to a participating Western Union location. Within minutes, we will receive a notification indicating to us that you have made your payment.

There are only two easy steps that you should follow:

Step One:
GO TO A LOCAL PARTICIPATING WESTERN UNION AGENT LOCATION

To find the nearest Western Union Agent location, contact us or call the telephone number of the Western Union Payment Services Network Agent in your country as listed in your phone book. You can also click on the word "location" in www.payment-solutions.com. Your local Western Union Network Agent, in turn, will let you know the participating Quick Pay location nearest you.

Step Two:
REQUEST AND FILL OUT THE BLUE FORM*

You must request a Blue Form at the participating local Western Union location. This form may show words such as "Payment Services" or "Quick Pay" printed in the applicable local language. However, please note that all Quick Pay forms will be blue.

Once you have obtained the Blue Form from the Western Union Agent, you must fill out all appropriate information. In addition to the payment amount, it is required that you include the following items:

NAME OF OUR COMPANY
This information must be entered in the "Company Name" line under the "Pay To" section of the blue form. (see A below)

OUR COMPANY CODE
This code must be entered in the "Company Code" line under the "Pay To" section of the blue form. (see B below)

YOUR REFERENCE WITH OUR COMPANY
(policy, name, account number, etc.). This information must be entered in the "Account Number" line under the "Sender" section of the Blue Form. (see C below)

Your First Name, Last Name, Address and Phone Number fields are also important. If you wish to send optional reference information to us, you may use the "Reference Number" or "Name/Department" fields printed at the bottom of the form.

Once you have made the payment, the Western Union Agent will issue a unique transaction identification number known as Money Transfer Control Number (MTCN). This is your confirmation.

*(Note: a Blue Form is not required in some Western Union Agent Locations, which are equipped with automatic receipt capabilities. Simply provide your information to the Agent verbally, or with the help of an auxiliary form.)