Fillable uest!Form! Stop!Payment!Req A"refund/fina nc ial"aid"check,"#" ,"in"the"am ou nt"of" (Florida Polytechnic University)

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uest!Form! Stop!Payment!Req A"refund/fina nc ial"aid"check,"#" ,"in"the"am ou nt"of" (Florida Polytechnic University)

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Stop!Payment!Req
uest!Form!
A"refund/fina nc ial"aid"check,"#" ,"in"the"am ou nt"of" $" was"mailed"to"me"on" ."
I!affirm!that:!
As"of"this"date,"I"have"not"received"the"check."
The"check"was"received"by"me"and"was"subsequently"lost,"misplaced"or"destroyed."
The"check"is"now"stale"dated/void"(check"attached)."
Please"place"a"stop"payment"on"this"check."I"acknowledge"that"thi
s"process"can"take"up"to"15#business#days#and"
that"if"I"subsequently"receive"or"recover"the"original"check"it"will"not"be"negotiable"and"must"be"returned"to"
Student Business Services."I"understand"that"if"for"any"reason"the"ori ginal"check"is"cashed"after"receiving"a"
replacement"check or after the funds have been disbursed into my bank account that my University records will be
placed on HOLD and"I"will"be"responsible"f or"repayment"of"the"amount"of"the"original"check."
Please!apply!the!check!to!my!account!to!pay!for!charges/fees/tuition.
!(NOTE:!If!the!
University!is!owed!money!from!a!current!or!past!term,!all!or!part!of!the!check!will!
be!applied!to!your!student!account.)!
!
Please!have!a!replacement!check!mailed!to!me.!I!understand!that!the!check!will!be!mailed!to!my!local!
mailing!address!on!file,!and!it!is!my!responsibility!to!make!sure!the!address!is!correct.!(If!you!have!
eDeposit!you!will!not!get!a!check)!
Please"provide"a"copy"of"the"front"and"back"of"the"check,"if"the"bank"shows"it"has"been"cashed"or"paid."
CONTACT!INFORMATION
Student! ID! #:___________________________________! Phone! #:! ______________________________________!
Name:!________________________________________!Email!Address:!_________________________________!
Signature:!___________________________________________________!Date:!____________________________!
Bring!the!completed!form!to!Student Business Services,!or!mail!to!the!address!below:!
STUDENT BUSINESS SERVICES:!REFUNDS!
Florida!Polytechnic!University!|!4700!Research!Way,!Room!1101A!Lakeland,!FL!33805-8531!
Student Business Services!
863.874.8406 I Room 1101A
4700 Research Way
Lakeland, FL 33805-8531
SBS@FloridaPoly.edu
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uestForm StopPaymentReq Arefundfina nc ialaidcheck, ,intheam ou ntof (Florida Polytechnic University)

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Completed 15 August 2020

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