Direct Deposit Authorization Agreement
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1ILLINOIS
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 Illinois 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 Number
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
Date
(required to validate this request)
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.
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