• OK Name is required
  • OK Please enter a valid Email address
  • OK Member Number is required
  • OK Transaction Amount is required
  • OK Company/Party Debiting Account is required
  • Optional OK Check Number is required
  • Expected Clearing Date

    OK Expected Clearing Date is required
  • One-time or Recurring

    OK One-time or Recurring is required
  • Optional OK Account holder authorized is required
  • Date Revoked

    Optional OK Date Revoked is required
  • The account holder agrees to provide United Equity Credit Union with written confirmation of the revocation within 14 calendar days from today's date. If United Equity Credit Union does not receive the required written confirmation, then it will honor subsequent debits to the account.

    By directing the Financial Institution to stop payment on the above transaction(s), the account holder agrees to hold the Financial Institution harmless against any and all loss, claims, damages, and costs, including court costs and attorney's fees, that the Financial Institution may suffer or incur by reason of non-payment of the above transaction if presented prior to withdrawal of these instructions or expiration thereof.

    The account holder understands that the stop payment request must be received at least three (3) business days before a scheduled debit(s) or in time to give the Financial Institution reasonable time to act upon it.

    The account holder also understands that it is necessary to provide the correct information related to the transaction(s) and that failure to do so may result in the payment of the above item(s). The account holder agrees to hold harmless and indemnify the Financial Institution for all expenses, costs, and damages incurred by payment of the above item(s) if such payment is the result of failure of the account holder to meet the time requirements noted above, or if such payment is the result of failure of the account holder to furnish any item of information requested above completely, accurately and correctly.

    I further state that the debit transaction(s) was not originated with fraudulent intent by me or any person acting in concert with me, and that the signature below is my own proper signature. I certify under penalty of perjury that the foregoing is true and correct.

Security Code

  • OK is required