ILLINOIS

STATE DISBURSEMENT UNIT

P.O. Box 5921

Carol Stream, IL 60197-5921

Customer Service: (877) 225-7077

 

DIRECT DEPOSIT CANCELLATION FORM

 

 

First Name:

 

 

 

 

 

Last Name:

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

Phone Number:

 

 

 

 

 

 

 

 

 

 

 

__________________________________________________________________________________________________________
           

Bank Name:

 

 

 

 

 

Bank Account Number:

 

 

 

 

 

Bank Routing Number:

 

 

 

 

 

 

List all docket/case numbers to which the direct deposit cancellation will apply:

 

Issuing County

 

Docket/Case Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I _____________________________, do not want my child support payments to be paid via direct
deposit anymore.

 

 

____________________________________________   __________________________

                              Signature (required)                                                                  Date

 

 

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

 

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.