Stop Payment - Check Trace Request Form

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Stop Payment / Check Trace Request Form
1. Name
2. Student ID:
3. Check Date or Semester of check that you are requesting:
4. Amount of Check: (US dollar)
5. Current / New Address:
Street:
City:
State:
Zip:
Phone Number :
E-mail:
If you have recently moved, please provide your previous mailing address for a Stop and Recover of the original.
6. Previous / Old Address:
Street:
City:
State:
Zip:
Phone Number :
E-mail:
Reissue check
Return funds to UMUC
Copy of Check
7. What action are you requesting for this check?
8. Direct Deposit: Are you enrolled in direct deposit?
Yes
No
Yes
No
If yes, and a stop payment is required, would you like the funds re-issued by direct deposit?
Please note:
You must change your address on the student portal at myumuc.edu before your request can be processed.
If you receive the check in the mail, after you have sent this request to us, you may not cash it. If you cash or deposit the check,
you will be liable for all cost incurred by your financial institution and UMUC.
By signing this I acknowledge that I have waited 30 days and have not received my refund check.
Signature
Date
Please fax to 301-985-7858 or 7502, or e-mail to
osacommunications@umuc.edu

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