Stop Payment Request
Fax Number: 1‐858‐350‐0443
City: _______________________________________ ________State: ___________________ Zip:
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
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
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 signing below I certify that I have read and agree to the terms and conditions of this request.
To Release Stop Payment
Release Date: ____________________________________________
The above Stop Payment Request is withdrawn.
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
Signature of bank representative: _____________________________________
BofI Federal Bank
Stop Payment Request_20110727V2