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Stop Payment Form

All information with an (*) beside it is required.

  Draft Information:

* Draft Account Number:

* Date of Draft:

* Draft Number:

* Amount of Draft:

 $

* Payable To:

* Name:

* Street Address:

* City:

* State:

* Zip Code:

Phone Number (Optional):

 ( )

  Image Verification:
  Verification Code:
  
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Please stop payment on the draft described above, unless you have already paid, certified, or accepted it. I understand that this request will cease to be effective 14 days from the date it is made unless you receive a signed request by mail, then it will be effective six month from the date it is made unless it is previously cancelled or renewed in writing by me. The Credit Union will not be liable for payment of the draft contrary to this request unless payment is caused by the Credit Union's negligence and causes actual loss to me. The Credit Union's liability shall not, in any event, exceed the amount of the draft. I agree to reimburse the Credit Union for any loss it sustains in honoring this request.


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