Stop Payment Request Form

Note: This form is to be used when you are not in possession of the check. If you are in possession of the check, complete the Cancel Check Form and send to Accounts Payable.

* = required field.

Contact Information

* Contact First Name: * Contact Last Name:

* Contact E-mail: * Contact Phone Number:

* Contact Department:

*Action Requested: Stop Payment and Reissue

Stop Payment with No Reissue

Check Information

*Check Number: Check Date:

Check Amount: DaFIS Document Number:

*Check Payee:

*Explanation:

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* Contact First Name:	* Contact Last Name:
* Contact E-mail:	* Contact Phone Number:
* Contact Department:

*Action Requested:	Stop Payment and Reissue
	Stop Payment with No Reissue

*Check Number:	Check Date:
Check Amount:	DaFIS Document Number:
*Check Payee:

*Explanation: