| STOP PAYMENT FORM |
| |
|
|
Last Name |
________________________________ |
MI |
______________ |
First Name |
________________________________ |
State |
______________ |
Street Address |
________________________________ |
Zip |
______________ |
City |
________________________________ |
Home Phone |
_________________________ |
| |
|
Work Phone |
_________________________ |
Account # |
________________________________ |
E-mail |
_________________________ |
Check # to Stop |
________________________________ |
Amount |
$______________ |
Payable To |
________________________________ |
Date Written |
______________ |
Disclosure: All items must be accurate or our computer systems will not properly stop payment. 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 or fax) |
_______________________________________
Signature
|
________________________
Date |
You Must Print, Sign, and Mail to Credit Union
or Fax to 404-845-5033
|
