Wisconsin Direct Deposit Form 1

WI SCTF
PO Box 07914
Milwaukee WI 53207-0914
TEL:
TDD:
800-991-5530
877-209-5209
Authorization Form: Direct Deposit
Please print and complete ALL the information below. We WILL NOT process forms with missing information.
Name: _______________________________________________
Address: _____________________________________________
City/State/ZIP: ________________________________________
Daytime Telephone: (______) _____________________________
Home Telephone: (______) _______________________________
Important
You must include a copy of your check
showing the account and routing numbers.
Write “Void” across your check
Your Child Support PIN Number: _________________________
(Contact your Child Support Agency if you do not know your PIN)
Social Security Number: _________________________________
Bank Routing Number: __________________________________
~ Sample Check ~
Your Name
(See sample check or contact your bank for the routing number)
Bank Account Number: _________________________________
(See sample check or contact your bank for the account number)
VOID
Pay to the order of ___________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Account Type:
Checking
Savings
(Check One)
l:0000000000l:
00000000000ll:
0000
Bank Name: ___________________________________________
Bank City/State: _______________________________________
I want to:
Sign up for Direct Deposit
Change My Account
Routing
Number
Account
Number
Cancel Direct Deposit
(Check One)
I agree: (Check One)
The whole amount of my direct deposit payment will NOT be moved to an account outside the United States.
The whole amount of my direct deposit payment will be moved to an account outside the United States.
Note: By signing this form you authorize the WI Support Collections Trust Fund (WI SCTF) to initiate payments to
the above account. You may check the date your payments were processed by the WI SCTF online at
childsupport.wisconsin.gov or by calling the WI Support Collections Trust Fund at the phone numbers listed above.
It takes at least 2 business days from the date the WI SCTF processes your payment for your bank or credit union to
credit a direct deposit payment to your bank account. It is very rare, but there might be further delays in the direct
deposit of support payments. We recommend that you confirm the direct deposit with your financial institution to be
sure the deposit transaction is complete.
You are responsible for ensuring that there are adequate funds in your account before withdrawing funds. The
Department of Children and Families and its vendors are not liable for overdraft fees and charges.
Please sign and date this form, then mail it to the address at the top of the form.
Signature: _____________________________________________
Office Use Only:
(R. 04/2010)
Date: _____________________________
Sent By: _______________ Date Received ____/____/____ Entered By: ________________