SAMPLE CHECK STOP PAYMENT

[Your Name]
[Address]

Date: [date] 

To:   [name of bank/person to stop payment] 
      [address] 
      [city, state, zip]

Dear [name or department]:

You are hereby directed to place a stop-payment order and refuse payment against the following account upon presentment of the following check:

CHECK INFORMATION
Payee: [name of person check made out to]
Check Number: [check number]
Amount: [dollar amount of check, e.g. $750.00]
Date: [date of check]

This stop-payment order shall remain in effect until further written notice. Please contact me if payment has already been made upon this check.

Thank you for your assistance.

[full name of account holder]
[account number]

__________________________
Signature