Stop Payment Form
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1Stop Payment Form
FAX, MAIL OR E-MAIL TO: businessoffice@cayuga-cc.edu
AUBURN CAMPUS 197 Franklin Street Auburn, NY 13021 Tel: (315) 294-8450 Fax: (315) 283-9010
Business Office
593-9304
FULTON CAMPUS 11 River Glen Drive Fulton, NY 13069 Tel: (315)
Fax: (315) 592-7735
Today’s Date
C# C______________
NAME
(please print)
Last
First
M
ADDRESS
(check will be mailed to)
Number and Street
Apt. #
City
State
Zip Code
TYPE OF CHECK (Please Check ONE):
Student Refund
Payroll
Check Date:_____________ Check Number: ______________________ Check Amount: ______________
Reason for Stop Payment _________________________________________________________________
_______________________________________________________________
____________________
SIGNATURE
DATE
FOR OFFICE USE:
Date Received ______________ Date Stopped ______________ Date to be re-issued _______________
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Parent category: Financial