Last
Name
|
_____________________________ |
|
| First
Name |
_____________________________ |
MI |
________ |
| Street
Address |
_____________________________ |
State |
________ |
| City |
_____________________________ |
Zip |
____________________________ |
| Work Phone |
_____________________________ |
E-mail |
____________________________ |
| Home Phone |
_____________________________ |
|
|
| Account
# |
_____________________________ |
|
|
| 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
|
