ACH DEBIT ACTIVITY STOP PAYMENT FORM (to be used to stop only the next ACH transaction) Form should be faxed to (562) 596-9975, ATTN: ESD Date of Request / / Account Number Last Name First Name Daytime Phone Amount RETURN CODE R08 - STOP PAYMENT ON SPECIFIC DEBIT ONLY Originating Company Name Date of Next Scheduled Payment / / Re-start date of Payment / / This form acknowledges members' request to stop payment on the preauthorized electronic funds transfer shown above. I understand there is a $25.00 fee for each ACH Stop Payment and my account will be debited accordingly. Unless the members' signature appears below, the request was orally made and shall not be binding on the credit union beyond 14 days from the date of this form unless confirmed in writing by the member within the 14-day period.   Member Signature                                                                              Date                      Instructions Recieved By                                                                    Date                        Time