Louisiana State University in Shreveport
Check Stop Payment Request
You may fax your completed stop payment request to LSU-S at the following
number: (318) 798-4141
Payee: __________________________________________________________________
Check Number: __________________________
Check Amount: _______________
Check Date: __________________________
Reason for Stop Payment: __________________________________________________
Issue New Check: Yes
No ___ (per bank regulations: 24 hours must elapse between
stop payment and check re-issuance.)
I hereby certify that I (we) have not received the above-mentioned check.
Completion of this request authorizes LSU in Shreveport to stop payment on the
check. I agree that if I (we) subsequently receive the stopped check, it will be
returned to LSU in Shreveport
Payee’s Signature: ____________________
Date: __________________
Office Use Only
Date: ________________________
Check Cleared?
No
Yes
Date: _______________________
Stop payment booked on voucher __________ and re-issued on voucher ____________
Note: For this stop payment to be effective, 24 hours must pass before the check is
re-issued. Record stop payment on check register.