Please type or print all information requested
Name
Valencia ID#
Address
Check #
City, State, Zip Phone #
Reason for Stop Request
Not received in mail Lost after received in mail
Moved from address currently
on
file
Other
By signing below, you acknowledge that you are requesting that a STOP PAYMENT action
be initiated for the check listed above. You verify that as of this date, you have not cashed
said check. You understand that a replacement check will be issued in approximately ten
(10) business days from when you initiated this transaction if eligible. You
understand that
if you are to receive/find this check you will not attempt to cash and/or
deposit said check
and in doing so, you will be responsible for all fees incurred.
Signature
Date
East West
Osceola
Please use FAIVNDH for the below information
Term (ex:201710) Business Office Rep
Amount
Check Date Check Number
Student Stop Payment Request
Business Office Use Only
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signature
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