Stop Payment Form - First State Bank Of Bedias Page 2
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3Timing of Stop Payment Order
I understand a stop payment order must be received in time to allow the institution a reasonable opportunity to act on it prior to
acting on the debit entry and for some ACH debits, the order must be received at least three banking days prior to the scheduled
date of the transfer. To be effective, the stop payment order must also sufficiently identify the payment. If the order is accepted
orally and notice is given that a written confirmation is required, the written confirmation must be received within fourteen (14)
days of the oral order. Properly signed Stop Payment Orders are effective for 6 months after the date received and will automatically
expire after that period unless renewed in writing. With respect to ACH debits, the institution and the undersigned agree to abide by
the ACH Rules and regulations regarding Stop Payment Orders.
AUTHORIZED SIGNATURE:
I request First State Bank of Bedias to stop payment on the check(s) or ACH items listed above. I agree to hold First State Bank of
Bedias harmless for the amount of the check and any loss, cost and/or expense incurred by reason of the bank refusing payment.
First State Bank of Bedias is not liable for payment contrary to this request if done through inadvertence, accident or otherwise lack
of good faith or failure to exercise due care, or by reason of payment other items drawn on the account are returned insufficient.
First State Bank of Bedias’ liability for payment contrary to this order shall in no event exceed the amount of the check.
Authorized Signature: _______________________________________________________ Date: _____________________________
Address: _____________________________________________________________ Telephone #: ____________________________
RELEASE OF STOP PAYMENT
I request First State Bank of Bedias to release Stop Payment on the above item.
Authorized Signature: _______________________________________________________ Date: _____________________________
Address: _____________________________________________________________ Telephone #: ____________________________
FSBB Use Only:
Verbal Request Rec’d
Date: _______________ Time: ________________ By: _________________________________________
Written Request Rec’d
Date: _______________ Time: ________________ By: _________________________________________
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