ACC Stop Payment

Choose an Option:*

Stop PaymentVoid VoucherVoid CheckReissue Check

Student/Vendor/Employee Name:*

First NameLast Name

ID Number:*

Address:*

Street Address

Street Address Line 2

CityState

Zip Code

E-mail:

example@example.com

Phone Number (Home):

Area CodePhone Number

Phone Number (Cell):

Area CodePhone Number

If known, original check number:

Date Refund Issued:*

MonthDayYear

Amount of Refund:*

Refund Term:

Refund Type:*

FALoanDropOther

Reason for Stop Payment:

StolenNever ReceivedMovedOther

My signature below indicates that I am requesting a stop payment on the above check for the reason indicated. I also understand that any attempt to cash the Original Check after the date of this Agreement, will be fraudulent. I agree that should the Original Check come into my possession, I will mark it “VOID” and return it to CSM. CSM may take any legal actions necessary to enforce its rights under this Agreement without prior notice or demand.

A replacement check, if still eligible, will be issued only after check has been outstanding for 30 days to the address on file at CSM.

IMPORTANT NOTICE CONCERNING ADDRESS CHANGES

It is the responsibility of the student/vendor/employee to maintain a current address with CSM. Any address changes must be made by filling out online form and returning to: For students the Admissions office at 8730 Mitchell Road, PO Box 910, La Plata, MD 20646, by fax at 301-539-4789, or in person at a campus admissions or registration office. For Vendors address changes need to be submitted to Accounts Payable. For Employees address changes need to be submitted to HR. This form DOES NOT initiate an official change of address. If the address is not changed prior to submitting this form, your refund check WILL be sent to the same address as the original check.

Student/Vendor/Employee Signature:*

Student/Vendor/Employee Information

Refund Check Information