ILLINOIS

STATE DISBURSEMENT UNIT

P.O. Box 5921

Carol Stream, IL 60197-5921

Customer Service: (877) 225-7077

 

DIRECT DEPOSIT AUTHORIZATION AGREEMENT

 

I, hereby authorize the State Disbursement Unit, (SDU) to initiate credit entries for deposit of child support payments
and if   necessary, to  initiate debit  entries and adjustments for any credit entries  made in error to  my account at the
Depository Institution named below.

Account Type (check one)

                          Checking Account

             Savings Account (Contact your bank to obtain the bank routing number and savings account number)

 

Name and Location of Bank

 

 

 

 

 

 

        Name of bank

 

City

State

                 Zip

Bank Routing Number

 

 

                    9-digit routing number

Bank Account Numbero

 

 

 

 

This authorization is to remain in full force and effect  until the SDU has received  written notification from me of its
termination in such time and in such manner as to afford the SDU and the Bank a reasonable opportunity to act on it.

 

Full Name:

 

Daytime Phone Number:

 

 

List all the docket numbers to which direct deposit authorization agreement will apply:

Docket Number

 

Issuing County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____________________________________________  __________________________

            Signature (required to validate this request)                                              Date

 

Please fax the completed form with the above referenced information to (630) 221-2312 or mail to the Illinois State Disbursement
Unit at the above address.  The process to  establish this  service requires   approximately 2-4 weeks.  In the interim, checks will
continue to be mailed to your address.


To receive notification on the status of your direct deposit application via a text message or an email from the State Disbursement Unit please provide the requested information below with your preferred method of notification.

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.