Rev. 11/18
CASH MANAGEMENT
email: ua-cash@alaska.edu
PAYROLL STOP PAYMENT REQUEST
Date of Request: ____________
Check Number: Date Issued: Amount:
Payee: _______________________________________________ UA ID#: _____________
Reason for stop payment request: _
Account to be charged for bank stop payment fee:
Authorized by: ____________________________________ ____________________________________
(signature) (printed name)
Campus/Department: _________________________ Reissue: ____________________
Requestor: ________________ Phone: ______________ E-mail : ____________________
CASH MANAGEMENT USE ONLY
Stop Date ____________________________________
Approved Date _________________________________
Signature _____________________________________