Request for Stop Payment on Check

Personal Letter

Dear …

RE: Account # ___(###)__ - Stop Payment on Check #__(###)__ - Dated __(date)__

Please consider this as written authorization to have a stop payment put on the following check written on __(Account Holder’s Name/my)__ account # __(###)__.

  1. Check Number __(###)__
  2. Dated: __(date)__
  3. Issued in the amount of $__(amount)__
  4. Payable to: __(Name of person/company check is payable to)__

__(Optional: I wish to have a stop payment placed on this check because__(briefly give reason)__. Please send confirmation acknowledging receipt of these instructions by contacting me via __(fax #/email address/phone #/etc.)__. I ask you to kindly debit the account mentioned above for the Stop Payment fee.

Thank you for your attention to this matter. I look forward to hearing from you soon.

Yours truly,

** (If dual signatures required on the account, include the following:)

Authorized Signature(s):

X_________________________ X_________________________

__( Name)__ __ (Name)__