NRFCU - Stop Payment/Closed Form

		Stop Payment/Closed Form


Member Name Member Account #
Stop Payment Check	Stop Payment ACH (Electronic Payment)	Closed Checking Account

Place	Delete
Beginning Check #
Ending Check #
Amount
Date of Check/ACH
Check/ACH Payable to
Reason for Stop

I understand that stop payments are valid for six months and that I may renew the stop payment. I understand that I will be charged $20.00 to place the stop payment.

Member Signature_________________________________________ Date_____________

Please print and sign this completed form and return to:

Northwest Resource FCU • PO Box 2788 • Portland, OR 97208

For Credit Union Use

Received By: __________________________________ Confirmation Code: ____________________________