Stop Payment Request Form

Member Name:	Date:
Member #:	Home Phone #:
Email Address	Cell Phone #:
Checking Money Market Plus Money Market Gold

(choose one)
Check
Check # Amount $ Payable to
Lost Check Book Check # Through

ACH/Electronic
Company Name:
For the Amount(s) of: All Specific Amount Specific Amount $
I would like this to stop: Expire On Expire on (date) Expire one year from today Be Removed

The member agrees to hold Island Federal Credit Union (the Drawee) harmless from liability, cost and expenses arising from the Drawee’s refusal to pay on item as to which the member has given a stop payment order. The Drawee agrees to exercise ordinary care in endeavoring to comply with a stop payment order, but if through inadvertence, oversight, accident or otherwise the Drawee pays the item contrary to a stop payment order the member and the Drawee agree that the Drawee shall be immediately entitled to charge the member’s account for the amount thus paid and such charge shall stand regardless of whether the member is entitled to recover from the Drawee on account thereof, and the member’s sole remedy shall be to prove and recover only such actual money damages as may be occasioned to the member solely on account of only such item. Phone orders are effective for 14 days unless submitted in writing and will be removed if form is not returned. Notification must be made at least 24 hours in advance for check requests and 3 days prior to any recurring ACH payment. A $25.00 stop payment processing fee will be deducted from the above account, as disclosed in our Current Fee Schedule. Should you wish to cancel the stop payment order, please contact 631-851-1100 ext. 2508.

Type the numbers you see above:

NOTE: Only click the Submit button once. Because it is encrypted, this transmission may take up to one (1) minute to complete.