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 # __(###)__.
- Check Number __(###)__
- Dated: __(date)__
- Issued in the amount of $__(amount)__
- 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)__