STOP PAYMENT FORM

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