Division of Business and Financial Affairs
Student Business Services
One University Drive
Camarillo, CA 93012
Phone (805) 437-8810
REQUEST TO ISSUE A STOP PAYMENT
*Requests for a new check will take 3 to 4 weeks to be processed from date form was received
Type of Refund (Check appropriate box)
Student Parent PLUS
Date:_______/________/______________ Fall Spring Year:_______________
Student Name:_______________________ ID#:___________________________________
Parent Name (If parent PLUS loan):_____________________________________________________________________
Payee Address:_____________________________________________________________________________________
City:__________________ state:________ Zip Code:____________ Primary Phone: ___________________________
Amount of Check:$____________________ Date Check was issued________/_______/________
Reason for Stop Payment and Reissue:
I moved and have not changed my address with the university.
It has been two or more weeks since the check was issued and I have not received it.
Check has been destroyed (Please attached original check with this form).
Check has expired (Please attach original check with this form).
I received the funds in error and I am returning the check to clear my debt with the university.
Other (please explain):_____________________________________________________________________________
_________________________________________________________________________________________________
New Check (Check desired option):
Direct Deposit: (Not Available for Parent PLUS Loan Refunds)-Please activate Direct Deposit via MyCi before submitting form.
Mail to the address on this form.
Picked up from the Student Business Services using the primary phone number indicated on this form.
* By signing below, I certify that I have not received the check listed above. I have checked my bank account to verify that the
check was not cashed. I understand that if I receive the check after I submit this form, I CAN NOT cash the check and must return
it to Student Business Services immediately. I also understand that I must change my address with the university if current
mailing address is incorrect to prevent future mailing discrepancies.
*Signature______________________________________________________________________________________
For Office Use (Direct deposit requests go to SBS Refunds manager)
Date form received:______/______/_________ Received By:_________________________
Voucher ID:_____________________________ Check # (If possible)___________________
Date new check was issued:________/________/_________ New Check#:________________________
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By signing, I certify that I have received the new check:_____________________________________________________
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