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ATTACHMENT A 'U 3&.,,~' Stop Payment/Restraint Request R<__... for stop order IOptional) Office I Phone request Date State Zip code Time I Work telephone number Received by Officer number OAdd stop payment o Delete stop payment DLCA D Checking/Savings DCD DIRA D Check o Credit Name Address City Home telephone number Account number At tion Payable to Single Item Date issued Check number Amount Replacement check issued DYes DNO If yes, check number Date Multiple Items Check number range Dollar range High Is this a pre-authorized or ACH debit/charge? Low High $ Low $ Fee Hold/Pledge Instruction DYes DHold DNo D Pledge DAdd D Change I Expiration date D Release Amount Description Description of Check I request the Bank to stop payment on my check described above. I have reviewed the above information and agree that it accurately describes the check which I want stopped. ~ r Procedures - check number provided I V check number is included in the above description, I understand that the Bank will only use my check number and my account r' ber to locate the check. I agree that the Bank will have no liability if either the check number or account number described above is incorrect and the Bank pays the check. Bank Procedures - check number not provided If my check number has not been given by me, I understand that the Bank will attempt to locate my check based on the other information I have given the Bank. I agree that the Bank will have no liability if I have made any error with respect to either the amount, date, name of payee or other information and the Bank pays the check. Term/Renewal Provisions This stop payment request will be effective for six months from the date it is received by the Bank. The Bank may, but is not obligated to, automatically renew my stop payment request for new six-month periods. If the Bank elects to automatically renew this request, I agree to pay the Bank a renewal fee. I understand that the Bank is not required to notify me of the expiration of this stop payment request or of any renewal of this request. After the expiration of this request, or after the expiration of any renewal of this request, the Bank may honor the check described above. Deposit Account Agreement or Terms of Line of Credit Agreement In addition to the terms set forth above, my stop payment request is subject to the provisions contained in the Deposit Account Agreement if it relates to a check drawn on a deposit account and subject to the provisions contained in the line of credit agreement if it relates to a check or draft drawn on a line of credit. I Date Customer signature x FW 44550 (9.98.228041-J) PII