DO NOT MAKE A DUPLICATE-IF ANOTHER CHECK IS GIVEN

    DRAW A NEW CHECK WITH DIFFERENT DATE AND NUMBER

    不要复制原支票，如果要再提款，请重新签发日期与编号均与原支票不同的新支票

CHICAGO_____________________20_________

芝加哥，                      日期：    

TO

致：×××银行

PLEASE STOP PAYMENT OF

请停止支付下列支票

CHECK No．_______________________

支票号码：

DATE______________________________

签发日期：

ISSUED to__________________________

收款人：

_______________________________________________________________________________

FOR $______________________________________________________

金额：$

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

请贵行收到所有信息后务必与顾客再核对一次止付数额。数额必须准确。

FOR THE FOLLOWING REASON：_________________________________

止付原因：

_______________________________________________________________________________

ACCOUNT NUMBER____________________________________________________________

账号：

TITLE OF ACCOUNT______________________________________________

账户名称：

_______________________________________________________________________________

BY ______________

AUTHORIZED SIGNATURE

签发人（或银行）签字

ADDRESS ____________________________________________________________________

地址：

PHONE NO _______________________________

电话：

FAX NO ________________________

电话:

___________________________________________              TIME     RECEIVED

_______________________________

TO _______________________________________

收件时间：                            致：

By ___________________                （注：在□内打×表示选择）

WILL                                 BOOKKEEPING DEPT.簿记处       □

须           }    CONFIRM ___________     UNIT TELLER收付款出纳    □

WILL NOT          确认               SPECIAL PAYER特别付款人       □

不须