_*** Print This Entire Page For Mailing - Keep A Copy For Your Records *** Mail Home Request Form
Clearly fill in all information below and mail the entire page with signed pawn ticket or confirmation letter to: E-Z Cash of Panama City, 807 E 15th Street, Panama City, Florida 32405
I realize that this loan has a time limit, and if that time limit is exceeded my property will be sold.
I, ________________________________, request that the property currently being held as collateral for a pawn loan by E-Z Cash of Panama City, be shipped to me by the most protective and efficient method. This service is limited to items weighing 20 lbs. or less.
Part I (Check which type document you are including)_ (_) I am including the original (yellow) copy of my pawn ticket, signed and dated on the back side, at the “X” in the lower right corner. (_) I have been renewing this loan, and I am enclosing the most recent confirmation letter that was sent to me, from E-Z Cash of Panama CIty, indicating the dates and amounts due. (_) I have had my signature below officially notarized. (This is mandatory for any transaction)
I understand and agree that my property will not be shipped to a PO BOX address. I am providing the shipping address below, and that I alone will be required to sign for receipt of the shipment. This signature will serve as proof of delivery.
I will also determine the value of my property for the purpose of acquiring insurance for the shipment. Failure to request insurance releases E-Z Cash of Panama City from all liability in the event of loss or damage of the shipment.
P=Part II _NAME ________________________________________________________________________________________________________ STREET ADDRESS (SHIP TO) ______________________________________________________________________________________ CITY __________________________________________________ STATE ___________________________ ZIP ___________________ PAWN NUMBER (CONTROL NUMBER found on pawn ticket) ________________________________
(_) PAWN AMOUNT $__________ from pawn ticket (_) SERVICE FEES $__________ from pawn ticket – use the correct date (maturity or default) (_) INSURANCE VALUE $_________ $__________ from insurance chart (X) POSTAGE (SELECT A or B) (A) $__13.90____ includes S/H for jewelry (B) $__23.90____ includes S/H for bulk up to 20 lbs. =========== Total due and enclosed $__________ (Postal Money Order Only) Part III (required) Customer Signed: _______________________________________ Notary: Signature______________________________________ _________________________________________ Today's Date: _________________________________ Notary Stamp: | | | | |______________________________________|