REQUEST BANK TO PLACE STOP-PAYMENT ON CHECK

REQUEST BANK TO PLACE STOP-PAYMENT ON CHECK

[DATE, ex. Wednesday, June 11, 1998]

[NAME, COMPANY AND ADDRESS, ex.
John Smith
XYZ Bank
1234 First Street
Suite 567
Anycity, Anystate  85245]

Dear [NAME, ex. John Smith],

I would like to request that a “stop-payment” be placed on the following check{s}:

CHECK #    AMOUNT    RECIPIENT        DATE        ACCOUNT #
[LIST CHECK NUMBER(S), AMOUNT(S), RECIPIENT(S), DATE(S) AND ACCOUNT NUMBER(S), ex.
12423        $1,203.23    ABC Co.        5/3/98        2132342-23423]

I hereby authorize the service charge to be deducted from my [savings / checking] account, #[CHECKING ACCOUNT NUMBER].

Sincerely,

[YOUR NAME, ex. Jill Jones]