STOP PAYMENT FORM
Last Name First Name         MI		Fairfield Federal Credit Union P.O. Box 5700 Pine Bluff, AR 71611 Fax: (870) 536-0243
Street Address                  City                State          Zip		Work Home E-mail
Account #		Check Numbers to Stop
Payable to
Amount		Date Written
Disclosure:   A verbal stop payment is good for fourteen days.  You need to sign and return this form to create a stop payment that is valid for 180 days.  Fairfield Federal Credit Union will not be responsible for checks that have already been processed or presented.  A fee of $15 per check or $25 fee for block of a check will be charged to your checking account for processing the stop payment request.
_______________________________    Signature	________________    Date
I further understand that due to the “No Stale Date” law of Georgia these funds can be withdrawn from my account after the 6 month stop payment has expired.  I also understand it is my responsibility to update any and all stop payments not the responsibility of my Credit Union.
_______________________________    Signature	________________    Date

You Must Print, Sign, and Return to Credit Union (by mail, fax or in person) A signature is needed to complete the process