Fillable Stop Payment Request Form printable pdf download

Stop Payment Request Form

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DIVISION OF FINANCE AND ACCOUNTING

VOID/STOP PAYMENT REQUEST

The original direct deposit (ACH) must not exceed 5 business days or the original check date must exceed 10 business days, in

order for the stop payment to be processed. Please fax a clear copy of your photo ID with this form. Allow up to 7 business

days from the receipt of this form for a replacement direct deposit (ACH) or check to be completed. If the original check is

found after this request has been submitted, do not attempt to deposit it and promptly return it to the

University of Central Florida, Finance and Accounting, 12424 Research Parkway, Suite 300, Orlando, FL 32826.

To Be Completed by Payee (Please Print)

To Be Completed by SAS/AP/Travel:

Please select the appropriate reason:

Incorrect Check Amount

Incorrect Payee

Payee:________________________________________

Duplicate Payment

Check Stolen

PID/VendID#:__________________________________

Incorrect Address

Check Never Received

______________________________________________

Other: ________________________________________

Current / Correct Mailing Address

Original Check is in our possession (check):

Yes

______________________________________________

City

State

Zip Code

Voucher#_____________

Phone #:_______________________________________

Check /ACH#:____________ Vendor ID#:_____________

Email Address: _________________________________

Check /ACH Amount: __________ Check/ACH Date: ____/____/____

I acknowledge with my signature below that I accept additional banking fees charged by my banking institution, if I have

attempted to cash the original check.

Requestor’s Signature: ___________________________________ Date: ____/____/____

Requestor’s Name (Print): ________________________________

Approved by: __________________________________________ Date: ____/____/____

___________________________________________________________________________________

Please request UCF Financials action by placing an “X” on one of the following void types:

Void/Reissue/Attachment (VRA)

Void/Hold(VH)

Void/Release Liability(VRL-UCF02 ONLY)

Form No. 41-911 (02/2015)

Stop Payment Request Form

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