888 North Nash Street, El Segundo, CA 90245-2879 • 310.563.5199 • AudioXpress 800.XFCU.222

Stop Payment Request
Member Name:
Address:
City / State / Zip:	, AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND NP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Account Number:
Check Number:
Check Amount:
Payable To:
A service fee will be charged to checking.
Please stop payment on the check described above unless you have already paid, certified or accepted it. I understand that this request will cease to be effective six months from the date shown below unless it is previously cancelled or renewed in writing by me. The Credit Union will not be liable for payment of the check contrary to this request unless payment is caused by the Credit Union's negligence and causes actual loss to me. The Credit Union liability shall not in any event exceed the amount of the check. I agree to reimburse the Credit Union for any loss it sustains in honoring this request.
Signature: __________________________________________   Date: ________________
CREDIT UNION USE ONLY Received by: Date: Signature:
PLEASE RETURN SIGNED COPY AS SOON AS POSSIBLE TO:
XCEED FINANCIAL CREDIT UNION 888 North Nash Street El Segundo, CA 90245-9975 Attn: Contact Center
or fax the completed form to 310.640.0727