STOP PAYMENT FORM
Account #
Last Name
Date
First Name
MI
Street Address
State
City
Zip
Work Phone
E-mail
Home Phone
Check # to Stop
Amount
Payable To
Date Written
Disclosure: All items must be accurate or our computer systems will not properly stop payment. This stop payment is good for fourteen days.
You need to print, sign and return this form to create a stop payment that is valid for 180 days
(in person or by mail)
_______________________________
Signature
________________
Date
You Must Print, Sign, and Return to Credit Union
(by mail, fax or in person)
A signature is needed to complete the process