CHECK STOP PAYMENT FORM
Form should be faxed to (562) 596-9975, ATTN: ESD

Southland Credit Union is herby directed to attempt to stop payment on the following check(s)
SINGLE Check Stop Payment on Account#
Check #: Amount : $
Payee: Date Issued: / /
Reason for Stop Payment: Lost Stolen Dispute Other
 
RANGE Check Stop Payment on Account #
Beginning (including) Check # to Ending ( including) Check #
Reason for Stop Payment: Lost Stolen Dispute Other

I understand that the check numbers and amounts I list must be correct for the Stop Payment to take effect.

I understand that if the Southland Credit Union (Credit Union) has obligated itself to pay the check (s), pursuant to California Commercial Code, Section 4304, or a third person becomes the holder in due course of the check(s), that the Credit Union may be obligated to pay the check(s).

I agree to indemnify the Credit Union against any and all liability, loss, costs, damages, fees of attorneys, and other expenses, including but not limited to any amount you are obligated to pay on the check(s), which the Credit Union may sustain or incur in consequence of honoring this Request to Stop Payment.

I understand that I must notify the Credit Union in writing if and when the reason for the Stop Payment(s) ceases to exist.

I understand that this request for the Stop Payment expires and is of no further effect one year from the date hereof.

The Credit Union will not be liable for paying any check (s) on the day the Request for Stop Payment is received.

I understand there is a $25.00 fee for each stop payment and my account will be debited accordingly.

 
MEMBERS NAME                                                                      
(Please Print)
DAY PHONE:                     
MEMBERS SIGNATURE:                                                             Date                     
RELEASE OF STOP PAYMENT
Release SINGLE Check Stop Payment on check indicted above.
Release entire RANGE Check Stop Payment on checks indicated above.
Release the following specific checks from the Range Check Stop Payment indicated above:
MEMBERS SIGNATURE:                                                                    

Date                     
   
FOR SCU
USE ONLY



Stop (s) Placed By:    Stop Date:    Stop (s) Released By: Stop (s) Release Date: