888 North Nash Street, El Segundo, CA 90245-2879 • 310.563.5199 • AudioXpress 800.XFCU.222
Teller Check Order to Resist Payment
Member and payee hereby request Xceed Financial Credit Union to issue a stop payment order on the above-mentioned Teller Check. That in order to induce the Credit Union to issue such a stop payment order and in consideration for the Credit Union's issuance of a stop payment. Member and payee agree to save and hold harmless Credit Union, it's successors and assign, from and against liability, damage, claim, loss or proceeding made or brought upon the credit union which it may suffer as a result of issuing the stop payment on the Teller Check. The member and/or payee shall furnish, upon demand, a bond or other security, as Credit Union may deem necessary to protect the Credit Union's interests under this agreement. In the event the Teller check shall hereafter come into the possession of Member or payee. Member or payee agrees to return the Teller check to the Credit Union. I acknowledge that the credit union draft, named above has not been delivered, endorsed, or assigned to any payee(s). Notice: The Credit Union will not honor this order if the check or draft has been delivered, endorsed, or assigned. I understand that you may not be able to resist payment on the above-described items. If you are unable to resist payment, I agree that you shall be entitled to charge my account for the amount paid and such charge shall stand regardless of whether I am entitled to recover from you on account thereof, and my remedy shall be to prove and recover only such actual damages as may be occasioned to me in connection with the payment of the item. I understand that I must supply you with exact information regarding the amount, the check number, the account number, the payee and the date of issuance of the credit union draft issued on my behalf. If I do not supply you with complete and accurate details regarding this item. I understand that this "Order to Resist Payment" may not be effective. I agree that you shall not be liable for payment of a teller check issued on my behalf, or credit union check issued on my behalf in the event the information on this form is in any manner not complete or accurate. I understand I must notify you if and when the reason for the Order to Resist Payment ceases to exist. I understand that this request to resist payment expires and is of no further effect six (6) months from the date hereof. I acknowledge receipt of a copy of this Order to Resist Payment and accept and agree to the terms hereof. I swear or affirm under penalty of perjury that the above stated facts are true and correct to the best of my knowledge. |
Member's Signature: ________________________________________ Date: _____________ |
Payee's Signature: ________________________________________ Date: _____________ |
State of: |
On the ____ day of ________________, in the year 20__, before me, the undersigned a notary public in and for said State, personally appeared ______________________________. personally known to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature(s) on the instrument, the individual(s), or the person on behalf of which the individual(s) acted, executed the instrument. |
Notary Signature: ________________________________________ |
PLEASE RETURN SIGNED COPY AS SOON AS POSSIBLE TO: |
| XCEED FINANCIAL CREDIT UNION 888 North Nash Street El Segundo, CA 90245-9975 Attn:___________________ Please mail in the original form to the address above. Faxed copies cannot be used. |