Get Stop Payment Form Adelphi

ADELPHI UNIVERSITY STOP PAYMENT/REPLACEMENT REQUEST Please return completed form to Adelphi University South Ave. Levermore 201 Garden City NY 11530 DATE NAME ID NUMBER DAYTIME PHONE NUMBER CHECK INFORMATION I certify that I have not negotiated the check referenced above. I have not received the proceeds from the above check. I have no knowledge of the disposition of this check. Should I receive this check after submitting this request I will immediately return it to Adelphi University. In the event that this check was paid by a bank I hereby request a copy in order to verify the endorsement and/or deposit information* I understand that if there is a question regarding this endorsement I must address my concerns to and take appropriate action with TD Bank at 855 Franklin Avenue Garden City NY 11530 Tel 516 739-2605 Payee s Signature DISTRIBUTION OF CHECK please choose one Pick up* Call the phone number below Mail to address listed below CHECK TYPE FOR OFFICE USE ONLY ACCOUNTS PAYABLE PAYROLL FILE 4Q 4V 4T 6/22/2010 CHECK AMOUNT. Levermore 201 Garden City NY 11530 DATE NAME ID NUMBER DAYTIME PHONE NUMBER CHECK INFORMATION I certify that I have not negotiated the check referenced above. I have not received the proceeds from the above check. I have no knowledge of the disposition of this check. I have not received the proceeds from the above check. I have no knowledge of the disposition of this check. Should I receive this check after submitting this request I will immediately return it to Adelphi University. Should I receive this check after submitting this request I will immediately return it to Adelphi University. In the event that this check was paid by a bank I hereby request a copy in order to verify the endorsement and/or deposit information* I understand that if there is a question regarding this endorsement I must address my concerns to and take appropriate action with TD Bank at 855 Franklin Avenue Garden City NY 11530 Tel 516 739-2605 Payee s Signature DISTRIBUTION OF CHECK please choose one Pick up* Call the phone number below Mail to address listed below CHECK TYPE FOR OFFICE USE ONLY ACCOUNTS PAYABLE PAYROLL FILE 4Q 4V 4T 6/22/2010 CHECK AMOUNT. Levermore 201 Garden City NY 11530 DATE NAME ID NUMBER DAYTIME PHONE NUMBER CHECK INFORMATION I certify that I have not negotiated the check referenced above. I have not received the proceeds from the above check. I have no knowledge of the disposition of this check. Should I receive this check after submitting this request I will immediately return it to Adelphi University. I have not received the proceeds from the above check. I have no knowledge of the disposition of this check. Should I receive this check after submitting this request I will immediately return it to Adelphi University. In the event that this check was paid by a bank I hereby request a copy in order to verify the endorsement and/or deposit information* I understand that if there is a question regarding this endorsement I must address my concerns to and take appropriate action with TD Bank at 855 Franklin Avenue Garden City NY 11530 Tel 516 739-2605 Payee s Signature DISTRIBUTION OF CHECK please choose one Pick up* Call the phone number below Mail to address listed below CHECK TYPE FOR OFFICE USE ONLY ACCOUNTS PAYABLE PAYROLL FILE 4Q 4V 4T 6/22/2010 CHECK AMOUNT.