Notice to Stop Payment of Check

Date: ____________________
_________________________
_________________________
_________________________
[name and address of financial institution]

Re: Stop payment of check

To Whom It May Concern:
This letter is to confirm my telephone request of _________________ [date] that you stop payment on the following check:
Name(s) on account: ________________________________
Account number: ________________	Check number: ________________
Payable to: ________________
Date written: ________________	Amount of check: ________________
Please acknowledge receipt of this notice by signing the duplicate of this letter and returning it to me in the enclosed stamped, self-addressed envelope.
Thank you for your assistance.

__________________________________________________
Signature

_______________________________
Printed or typed name

_______________________________
Address

_______________________________	_______________________________
Home Phone	Work Phone
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Receipt acknowledged by:

__________________________________________________ Date ________________
Signature

_______________________________
Printed or typed name

_______________________________
Title