REQUEST FOR STOP PAYMENT FORM
Date of Request: _____________
Employee Name: __________________________ NSU ID#: ________________
Contact Phone/Ext: __________________ Department: _________________________
Employee Address: __________________________________
__________________________________
__________________________________
Date of Original Check: ___________________
Reason for Request: __________________________________
__________________________________
__________________________________
How should the reissued check be delivered?
☐ Mail (please make sure address is updated above)
☐ Pick up check in Person from Payroll (picture ID required)
PAYROLL IS LOCATED ON THE EAST CAMPUS:
3100 SW 9
TH
AVENUE, FORT LAUDERDALE 33315
I authorize the NSU Payroll Department to place a stop payment on the above check that I have
not, nor will I, cash the check I am requesting the stop payment on.
_____________________________ ___________________
Employee Signature Date
Send completed form to the Payroll Department at payroll@nova.edu, fax (954) 262-3997, or
call (954) 262-7887 with questions.
Revised 09/20/2018
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signature
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