Stop Payment Order

Draft Date

Account Number

Name

Pin Number

Draft Number

Draft Amount

Payable To

Please stop payment on the draft described above, unless you have already paid, certified or accepted it. I understand that this written request will cease to be effective six (6) months from today's date. 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 in sustains in honoring this request.

I understand that there is a $15.00 per draft fee for doing this transaction.

By submitting this request I agree to the above terms.