Stop Payment Disclosure

On the terms hereinafter set out, you the account holder instructs First Citizens State Bank, hereinafter called “Bank” to stop payment on a designated check. Stop Payment requests using Online Banking may only be used for checks you have written, not for electronic debits (eg. Utility bills, insurance, etc). The stop payment order shall remain in effect for six (6) months.

A charge of $24.00 will be assessed to you as payment for implementing each check stop payment order.

By directing the Bank to stop payment on a check you agree to hold the Bank harmless against any and all loss, claims, damages, and costs, including court costs and attorney’s fees that the Bank may suffer or incur by reason of non-payment of the above transaction if presented prior to withdrawal of these instructions or expiration thereof.

You understand that the stop payment request must be received at least three (3) business days before the check arrives or in time to give the Bank reasonable time to act upon it. You also understand that it is necessary to provide the correct information related to the transaction(s) and that the failure to do so may result in the payment of the check. You agree to hold harmless and indemnify the Bank for all expenses, costs, and damages incurred by payment of the check item(s) if such payment is the result of failure by you to meet the time requirements noted above, or if such payment is the result of failure by you to furnish any item of information requested completely, accurately and correctly.

You further state that the transaction(s) was not originated with fraudulent intent by you or any person, and that by placing this stop payment you are agreeing to this disclosure and you certify under penalty of perjury that the foregoing is true and correct.