Stop Payment Request Form

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Stop Payment Request 
Fax Number:  1‐858‐350‐0443
 
 __________________________________________________________________________________________________ 
Name:
_________________________________________________________________________________________________ 
Address:
 ________________________________ 
City: _______________________________________ ________State: ___________________ Zip:
 ______________________________________
________________________________________________  
Phone Number:
Email: 
 
 
    Check (6 month stop payment)
 
 
    ACH (one time stop only, will not stop future/recurring debits – will remain in effect until this debit is returned or the stop is 
 
withdrawn) (R08)
 
Account Number: ___________________________________________________________________________________________________ 
Check # (N/A for ACH): _________________________________Amount$______________________________________________________ 
Payee/Debiting Company: ____________________________________________________________________________________________ 
Date Written/Authorized:  ____________________________________________________________________________________________ 
 
I am requesting the BofI Federal Bank to place a stop payment on a check or an ACH debit to my account referenced above.  I understand that if 
the item is presented and does not exactly match the information provided on this form that it may be paid.  I also understand that unless my 
request is received by BofI Federal Bank in a reasonable time for the Bank to act on my order (prior to payment of the check or 3 business days 
before the scheduled date of the ACH) that I cannot hold BofI Federal Bank responsible.  I also understand that if I wish to cancel this request 
that I must do so in writing.   
I understand that if the item is presented in a different method than I have indicated, the item may still be paid with no liability to BofI Federal 
th
Bank.  I understand that if this form is not completed and returned within 14 calendar days, my stop payment will expire on the 14
 day of the 
request.  I understand that I will incur a fee for placing this stop payment. Stop payments will expire after 6 months unless instructed otherwise 
by me.   
   
By signing below I certify that I have read and agree to the terms and conditions of this request.
 
Signature: ________________________________________________ 
 
 
Date: ____________________________________________________
 
To Release Stop Payment 
 
Release Date: ____________________________________________ 
The above Stop Payment Request is withdrawn. 
Signature: ______________________________________________ 
 
Fax completed form to: 1‐858‐350‐0443 or mail to: 
BofI Federal Bank 
P.O. Box 509127 
San Diego, CA  92150‐9948 
 
BANK USE ONLY
 
‐Verbal stop placed on (date):____________ form emailed for signature on (date):______________ will expire on (date):____________ if 
signed copy not returned. 
‐ACH payment stopped and returned on (date):___________________________.  Remove from system so that future/recurring debits are not 
stopped.  
Signature of bank representative: _____________________________________ 
 
 
 
BofI Federal Bank
Stop Payment Request_20110727V2 
 

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