Stop Payment Request And Indemnification Agreement Form

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333 North Central Avenue • Second Floor • Hartsdale, New York 10530 • Phone: (914) 946-6200 • Fax: (914) 946-2910
Branch Office: 22 West 1st Street • Room 311 • Mt. Vernon, New York 10550 • Phone: (914) 664-2646 • Fax: (914) 664-7991
Stop Payment Request and Indemnification Agreement
AGREEMENT made _________________________ between EDUCATIONAL & GOVERNMENTAL
EMPLOYEES FEDERAL CREDIT UNION and _____________________________________________.
NOW, THEREFORE, IT IS AGREED between the undersigned as follows:
1. Check number __________was drawn on account number ______________at Credit Union in the amount of
$__________________, dated _______________, made payable to ___________________________________
and was issued to Member at the request of an upon payment from Member.
2. That Member hereby requests Credit Union to issue a stop payment order on the Teller’s check.
3. That in order to induce Credit Union to issue such a stop payment order and in consideration for the Credit
Union’s issuance of a stop payment, Member agrees to save and hold harmless Credit Union, its successors and
assigns, from and against any liability, damage, claim, loss or proceeding made or brought upon Credit Union
which it may suffer as a result of issuing the stop payment on the Teller’s check.
4. That Member shall furnish, upon demand, a bond or other security as Credit Union may deem necessary to
protect the Credit Union’s interest under this Agreement.
5. In the event the Teller’s Check shall hereafter come into the possession of Member, Member agrees to return
the Teller’s Check to Credit Union.
Member Signature
Print Member Name
Name: __________________________
Title: __________________________
Rev. 2-2013


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Parent category: Legal