Payment by Western Union

Remit to :

John F. Bousquet,11550 S. Harlan Rd #30, Lathrop, CA, 95330-9730

(209) 983-0019

I need the following information sent to me. It should match the information submitted to Western Union on the transmittal document.

Your First Name:

Your Last Name:


Phone with Area Code :

Western Union MTCN   

Amount :


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