Place a Stop Pay on an Electronic Payment (ACH)

Please complete the following to request a Stop Payment on an Electronic Payment:

Full Name *

Member Number *

Please provide your preferred contact information

Dollar Amount of Electronic Payment *

Issue Date *

Originating Company *

Reason for Stop (Choose One)

Revoking Authorization of Recurring Electronic Payments

Revoking a One-Time only Electronic Authorization

Please read the following before submitting:

I understand by submitting this electronic Stop Payment form I am agreeing to all the conditions as mentioned below.
I will notify the originating company of this stop payment.
I understand that the amount I list above must be correct for the stop payment to take effect.
I agree to indemnify and hold FPCCFCU CU harmless from all liability, damage, and expense incurred as a result of refusing payment of ACH.
I understand I must notify you in writing, if, and when the stop payment ceases to exist.
I understand that a written request remains in effect unless I withdraw the request.
You must give the credit union advance notice at least one business day before the scheduled date of payment.
I agree to allow FPCCFCU to charge my account $30.00 for this stop payment request and acknowledge receipt of a copy of this order if I so request and accept and agree to the terms thereof.

I agree that I have read all information above. *

Yes, I agree.