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________________________________________________
________________________________________________
DIRECT DEPOSIT FORM
Please choose how y ou would like to receive your child support and/or alimony
payments. Please mark your choice below:
Direct Deposit to a Checking A
ccount: I authorize the deposit of my support
payments directly into my checking account.
Direct Deposit to a Savings Account: I authorize the deposit of my support
payments directly into my savings account.
I understand the following: my banking information will be kept confidential and all
future payments on this case will be sent to the account I have selected. My mailing
address and phone number will be updated with the information provided below.
ENROLLMENT INFORMATION
Name: __________________________________ Date: ________________
Case Number: ________________________________________________
Account Number: ________________________________________________
Routing Number: ________
________________________________________
Mailing Address: ________________________________________________
Phone Num
ber: _________________________ Date of Bir
th: _____________
Please include a voided check
or a letter from your bank and a copy of your ID
along with this form and return it choosing one of the following options:
Mail:
Clerk of Circuit Court
and Comptroller
PO BOX 3597
West Palm Beach, FL 33402
Fax: (561)355-7009
Email: childsupport@mypalmbeachclerk.com
***Please note that direct deposit requests can take up to 48 hours to be processed once received.***
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