Stop Payment/Void Check Request Form
Type of Request: ☐ Stop Pay & Reissue ☐ Void/Do Not Reissue (Attach check to form)
☐ Stop Pay-Title IV Return ☐ Void & Reissue (Attach check to form)
Reason for Stop Payment/Void: ☐ Lost ☐ Destroyed ☐ Check Not Received by Vendor
☐ Stale Dated ☐Other
Explanation if “Other”:
Amount of Check:
T Number:
Vendor Name:
If a reissuance is needed and the university does not have possession of the check,
the payee must sign the following statement:
Please process a stop payment and reissue the above mentioned payment. If the original check
is found or delivered to me at a later date, I will return it promptly to the
University. Arkansas Tech University reserves the right to charge the payee the cost of the
checks and any other costs incurred plus interest in the event that both checks are cashed by
the payee.
For Controller’s Office Use Only:
Confirmation check is outstanding (date & initial): ________________________________________
Check Cancelled/Voided in Banner (date & initial): ________________________________________
Check Cancelled/Voided in Evisions (date & initial): _____________________________________
Mailing Address:
