STOP PAYMENT ORDER 

To: ________________________________ 
____________________________________
____________________________________

You are hereby directed to stop payment on the following check on
my account: 

Account number: ____________________

Check number: ______________

Amount of the check: $ ______.___ ( _____________________________ 
& ____/100 dollars) 

Payee of the check: __________________________________________

This order is made under and subject to the provisions of Section
4-403 of the Uniform Commercial Code of the State of ___________. 



Dated: _____________________________ 



____________________________________________ 

____________________________________________

____________________________________________ 

____________________________________________