ACH Stop Payment Form

Form Instructions

Not to be completed for Debit Card, Credit Card, or Bill Pay transactions. Please complete the entire form, incomplete forms may not be processed in a timely manner.

Print, sign and mail or deliver to :
Star One Credit Union
P.O. Box 3643
Sunnyvale CA 94088-3643

To submit this form electronically, log into Online Banking and select "ACH Stop Payment Order" in the "Forms" menu.

Your Information

Date of Request

Member Number

Checking Savings

Member Name

Daytime Telephone Number

Frequency

One-Time Stop Permanent Stop

Amount

Any Amount Specific Amount

If specific amount, how much?

Company Name (exactly as shown on your statement)

Please stop payment on the electronic debit described above, unless you have already paid or accepted it. I understand this ACH Stop Payment request will remain indefinitely, unless it is subsequently canceled in writing by me and it must be received by the Credit Union at least (3) three business days before the scheduled date of transfer in order to be effective. The Credit Union may accept a stop payment order after that time, but will not bear any liability if it does not act on the order. The Credit Union will not be liable for payment of an electronic debit contrary to this request unless payment is caused by the Credit Union's negligence and causes actual loss to me. The Credit Union's liability shall not, in any event, exceed the amount of the electronic debit. I agree to reimburse the Credit Union for any loss it sustains in honoring this request.

I authorize a fee of $5.00 to be charged to the account referenced above for the Stop-Payment.

___________________________________________
Authorized Signature

_______________________
Date

Star One Credit Union use only

Received by (Operator ID and Initials)

Date

Fee

Charged Waived

Rev: 04/01/2016

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