STOP PAYMENT REQUEST ORDER Date* Time* : HH MM AM PM Account type:*ConsumerCorporateAccount name:*Contact phone number:*Payable to:*Transaction amount:*Please enter a value greater than or equal to 1.00.Expected clearing date of item(s):* Reason for stop payment:*Account number:*Date check(s) written:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920If applicable...Check serial number(s):If applicable...Select from the below options:* Single ACH payment (Consumer account) Recurring ACH entries (Consumer account) One ACH payment (Corporate account) Check SINGLE ACH PAYMENT (Consumer account) Terms and Conditions: On the terms hereinafter set out, the undersigned account holder hereby instructs......hereinafter called “the Financial Institution,” to stop payment on the above transaction. The stop payment order shall remain in effect (1) until written notice is received from the account holder to revoke the stop payment order; or (2) until payment of the entry has been stopped, which ever occurs first.RECURRING ACH ENTRIES (Consumer account) Terms and Conditions: On the terms hereinafter set out, the undersigned account holder hereby instructs...Verify standard entry class code:PPDTELWEBIAT...hereinafter called “the Financial Institution,” to stop payment on the above transaction(s). The account holder authorized...to originate one or more ACH entries to debit funds from the above account, (1) but on...DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920...revoked that authorization by notifying......in the manner specified in the authorization; or (2) will be notifying......on the following date...DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920...in the manner specified in the authorization. (Financial Institution check if applicable) If the Financial Institution checks this box then the account holder agrees to provide the Financial Institution with written confirmation of the revocation with... ...within 14 calendar days from today’s date. If the Financial Institution does not receive the required written confirmation, then it will honor subsequent debits to the account.ONE ACH PAYMENT (Corporate account) Terms and Conditions: On the terms hereinafter set out, the undersigned account holder hereby instructs......hereinafter called “the Financial Institution”, to stop payment on the above transaction. The stop payment order shall remain in effect for six months.CHECK Terms and Conditions: On the terms hereinafter set out, the undersigned account holder hereby instructs......hereinafter called “the Financial Institution”, to stop payment on the above transaction. The stop payment order shall remain in effect for six months.By directing the Financial Institution to stop payment on the above transaction(s), the account holder agrees to hold the Financial Institution harmless against any and all loss, claims, damages, and costs, including court costs and attorney’s fees, that the Financial Institution may suffer or incur by reason of non-payment of the above transaction if presented prior to withdrawal of these instructions or expiration thereof. The account holder understands that the stop payment request must be received at least three (3) business days before a scheduled debit(s) or in time to give the Financial Institution reasonable time to act upon it. The account holder also understands that it is necessary to provide the correct information related to the transaction(s) and that failure to do so may result in the payment of the above items(s). The account holder agrees to hold harmless and indemnify the Financial Institution for all expenses, costs, and damages incurred by payment of the above item(s) if such payment is the result of failure of the account holder to meet the time requirements noted above, or if such payment is the result of failure of the account holder to furnish any item of information requested above completely, accurately and correctly. I am an authorized signer, or otherwise have authority to act, on the account identified in this statement. I attest that the debit above was not originated with fraudulent intent by me or any person acting in concert with me. I have read this statement in its entirety and attest that the information provided on this statement is true and correct.A $30 application fee will be applied for each stop payment requested and will be withdrawn from your Focus Federal Credit Union account at the time your request is approved. I (account holder) release the Financial Institution from its obligation to stop payment on the above transaction(s). Account holder's name:* First Last Account holder's signature:*Date* NameThis field is for validation purposes and should be left unchanged.
