P.O. Box 5921

Carol Stream, IL 60197-5921

Customer Service: (877) 225-7077


EPPICard™ Cancellation Form



First Name:






Last Name:






Social Security Number:






Street Address:


















Phone Number:






Email Address:













List all the docket numbers to which EPPICard™cancellation will apply:


Docket Number


Issuing County or FIPS Code


















I, _____________________________, do not want my child support payments to be paid via EPPICard
MasterCard anymore. I understand that the ILSDU will not  credit any remaining balance in the form of a
check or Direct Deposit. It is my responsibility to clear my balance from this card.



____________________________________________   __________________________

            Signature (required to validate this request)                                            Date



Please fax the completed form to (630) 221-2312 or mail to the Illinois State Disbursement Unit at
the address noted above.


If you would like to receive notifications from the State Disbursement Unit that there has been a disbursement on your child support case listed above, please complete the requested information below.

Mobile phone number: __________________              Email: ________________________________

    (Standard Text Messaging rates may apply)                                                        (Please print and write clearly)

Preference (Circle One): Text Message     Email Message

If both mobile phone number and email address are provided but no preference is indicated the notification method will default to email.