DO NOT MAKE A DUPLICATE-IF ANOTHER CHECK IS GIVEN

    DRAW A NEW CHECK WITH DIFFERENT DATE AND NUMBER

    不要復(fù)制原支票，如果要再提款，請重新簽發(fā)日期與編號均與原支票不同的新支票

CHICAGO_____________________20_________

芝加哥，                      日期：    

TO

致：×××銀行

PLEASE STOP PAYMENT OF

請停止支付下列支票

CHECK No．_______________________

支票號碼：

DATE______________________________

簽發(fā)日期：

ISSUED to__________________________

收款人：

_______________________________________________________________________________

FOR $______________________________________________________

金額：$

BE CERTAIN TO RE-VERIFY AMOUNT OF STOP PAYMENT WITH CUSTOMER AFTER YOU HAVE RECEIVED ALL INFORMATION．THE AMOUNT MUST BE EXACT．

請貴行收到所有信息后務(wù)必與顧客再核對一次止付數(shù)額。數(shù)額必須準(zhǔn)確。

FOR THE FOLLOWING REASON：_________________________________

止付原因：

_______________________________________________________________________________

ACCOUNT NUMBER____________________________________________________________

賬號：

TITLE OF ACCOUNT______________________________________________

賬戶名稱：

_______________________________________________________________________________

BY ______________

AUTHORIZED SIGNATURE

簽發(fā)人（或銀行）簽字

ADDRESS ____________________________________________________________________

地址：

PHONE NO _______________________________

電話：

FAX NO ________________________

電話:

___________________________________________              TIME     RECEIVED

_______________________________

TO _______________________________________

收件時間：                            致：

By ___________________                （注：在□內(nèi)打×表示選擇）

WILL                                 BOOKKEEPING DEPT.簿記處       □

須           }    CONFIRM ___________     UNIT TELLER收付款出納    □

WILL NOT          確認(rèn)               SPECIAL PAYER特別付款人       □

不須