Stop Payment Form - Usc Credit Union
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1STOP PAYMENT FORM
Name: __________________________________
Account #: ____________________
OPTION 1: STOP PAYMENT REQUEST
USC Credit Union is hereby directed to attempt to stop payment on the following check(s):
SINGLE CHECK
SERIES OF CHECKS
Check #: ____________________
Starting Check #: _____________________
Amount: _ ________________ _
Ending Check #: _____________________
Date Issued: _________________
Payee: ______________________
Reason for Stop Payment:
Lost
Stolen
Dispute
Other: ________________
………………………………………………………………………………………………………
I understand that the check numbers and amounts I list must be correct for the Stop Payment to take effect.
I understand that if USC Credit Union has obligated itself to pay the check (s), pursuant to California Commercial
Code, Section 4304, or a third person becomes the holder in due course of the check(s), that the USC Credit Union
may be obligated to pay the check(s).
I agree to indemnify USC Credit Union against any and all liability, loss, costs, damages, fees of attorneys, and
other expenses, including but not limited to any amount you are obligated to pay on the check(s), which USC Credit
Union may sustain or incur in consequence of honoring this Request to Stop Payment.
I understand that I must notify USC Credit Union in writing if I wish to cancel the Stop Payment.
I understand that this request for the Stop Payment will remain in effect for six months from the date of the request
and a new Request to Stop Payment is required to renew the six-month period.
I understand USC Credit Union will not be liable for paying any check (s) on the day the Request for Stop Payment
is received.
I understand a $20.00 fee will be assessed for each single stop payment or a $30.00 fee for range of checks.
Signature: __________________________________
Date: ___________________
………………………………………………………………………………………………………
OPTION 2: STOP PAYMENT RELEASE
Release stop payment exactly as indicated above.
Release stop payment on these specific check numbers: ___________________________
Signature: __________________________________
Date: ___________________
USCCU USE ONLY PROCESSED BY PROCESSED DATE
REQUEST
RELEASE
Revised October 2015
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