Request to stop payment on check

1234, Main Street
Boston, MA 02123

04 April, 2005

<Recipient Address Goes Here>

Hello,

Re: Request for Stop Payment
Account No. <number>

I am writing to request that you stop payment on a check written on the above-referenced account. I would like to stop payment on check number <check number>, which was issued on <date>, and made payable to <payee>. The check was issued in the amount of <amount>.

I would appreciate it if you would provide me with written confirmation that payment on this check has been stopped. Thank you for your assistance in this matter.

Regards,

Robert Anderson

encl: <List of enclosed items goes here>

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