1234, Main Street
Boston, MA 02123
05 April, 2005
<Recipient Address Goes Here>
Hello,
You are hereby requested to refuse payment upon presentation of the following check or draft on my account number <Account Number>:
Check Number: <Check Number>
Check Date: <Check Date>
Amount: <$Check Amount>
Payee: <Name of Payee>
If this check has already cleared, please let me know immediately.
Regards,
Robert Anderson
encl: <List of enclosed items goes here>
Do you have sample letter of request to stop payment on credit cards?