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{DATE, ex. Wednesday, July 11, 2006}



{Name, Company & Address, ex.
Mark Myer
XYZ Bank
1234 First Street
Suite 567
Anycity, Anystate  85245}

Dear {NAME, ex. Mark Myer},

I would like to request that a "stop-payment" be placed on the following check{s}:

CHECK #          AMOUNT          RECIPIENT                   DATE                ACCOUNT #
{LIST CHECK NUMBER(S), AMOUNT(S), RECIPIENT(S), DATE(S) AND ACCOUNT NUMBER(S), ex.
12423               $1,203.23          ABC Co.                       5/3/98               2132342-23423}

I hereby authorize the service charge to be deducted from my {savings / checking} account, #{CHECKING ACCOUNT NUMBER}.

Sincerely,



{YOUR NAME}

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