This is to authorize you to place a "STOP PAYMENT" order on the following check:
Account #: _____________________
Account Name: __________________
Check #: _______________________
Name of Payee: _________________
Date of Check: _________________
Amount of Check: _______________
Thank you for your immediate attention to this matter. If you should find any trouble with this transaction, please call me at (XXX) XXX-XXXX between 0:00 a.m. and 0:00 p.m.