EFT Authorization For Direct Deposit Or Direct Payment {04-0008}

Direct Deposit Stop going to the bank to cash your checks and start receiving your payments in your bank account. Here are just a few reasons why you should sign up for Direct Deposit today: · · · · It's easy and secure On time, every time Saves you trips to the bank Works, even when you are away from home · · · · Gives you quick access to your money Eliminates the risk of lost or stolen checks Enables you to avoid other fees Helps protect the environment Sign up for Direct Deposit today! Getting started is easy... Simply fill out the Authorization Form below. Just be sure to sign and date the form and fax it to 907-787-3220 or mail it to the following address: Child Support Services Division 550 W 7th Ave, Suite 310 Anchorage, AK 99501-6699 Direct Deposit Authorization Form Custodial Parent's Name (please print) Mailing Address First Middle Initial Last Street Address or PO Box City State Zip Daytime Phone (____ ) __________ Social Security Number_______________________________ Date of Birth ____/____ /_____ CSSD Member ID# _________________________________ SSN is not required for direct deposit. It is used to assist In the identification of your bank and financial account. This is the 8-digit Member Number assigned by CSSD, not your case number. Account Type Checking Savings Attach a check or deposit slip, locate your banks routing number and your account number. Name of bank or financial institution: ______________________________ Routing Number _________________________ Account Number ___________________________________ I authorize the State of Alaska CSSD to make necessary adjustments to the above account to correct any credit entries made in error. I understand that the CSSD will make a reasonable effort to notify me within 24 hours when an adjustment is made. This authority remains in effect as long as I have an open child support case with the State of Alaska CSSD. I understand that 30 days written notice is required to change financial institutions, account numbers, or account type and that I must notify CSSD if I close my account or change my mailing address. American LegalNet, Inc. Signature (required) _________________________________ Date (required)___/_____/____ www.FormsWorkFlow.com For more information, call the Alaska Child Support Services Division at (907) 269-6900. Only one form is required even if you have multiple cases. 04-0008 (07/09/15)