Notice To Bank To Stop Payment On Check

Date:

To:

Gentlemen:

You are hereby directed to place a stop payment order and refuse payment upon presentation of the following check:

Name of Payee:

Date of Check:

Amount:

Check Number:

This stop order shall remain in effect until further written notice.

___________________________

Name of Account

___________________________

Account Number

By:___________________________

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Notice To Bank To Stop Payment On Check