This form is provided as a convenience to you for requesting the termination of payment on a single check number to a single payee. This is not a way to notify us that your checks have been lost or stolen.  In the event of such a loss, please call our customer service department immediately at 715-597-3136.

There is a nominal fee to cover the paperwork involved in this request,  and it will automatically be deducted from your checking account upon receipt of this form.  See disclosures for the fee.
 

In requesting United Bank to stop payment of this item, the undersigned agrees to hold United Bank harmless for all expenses and costs incurred by United Bank on account of refusing payment thereof, and further agrees not to hold United Bank liable on account of payment contrary to this request if the same occurs through inadvertence, accident, or oversight, or if by reason of such payment other items drawn by the undersigned are returned insufficient.   Stop payment orders are automatically released at the expiration of 180 days from the date of the order unless renewed in writing.

Personal Information

* Required Fields

Name:

*

Home Address:

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City:

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State:

Zip Code:

*

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E-mail:

*

Home Phone Number:

*

Account Number:

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Check Number:

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Check was made out to:

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Date written:

*

(mm/dd/yyy)

Amount of Check:

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Reason for stopping payment:

*

Please fill out completely.

Copyright 2004. 
United Bank
We serve the communities of
Osseo, Strum, Eau Claire, Eleva, Ettrick, & Mondovi, Wisconsin.
Questions or comments, please contact  us.