SDU Direct Deposit Form 1 R062519
STATE OF FLORIDA DISBURSEMENT UNIT
DIRECT DEPOSIT INFORMATION FORM
Name
Case No. SS #
Address
City County State Zip
I have authorized to automatically
(Company Name)
Deposit my Child Support Payments at
(Bank Name)
(City, State)
Bank transit routing number:
To the account selected below:
ONLY one account can be selected for direct deposit of child support payments
Checking account number
PLEASE ATTACH A VOIDED CHECK
Savings account number
PLEASE ATTACH A VOIDED DEPOSIT SLIP
I understand that the full amount collected will be deposited. I also authorize the Bank to accept the deposit for
my account and to make adjustments to my accounts that correct any error relating to the deposit.
This authorization will remain in effect until revoked by me in writing or canceled by the Bank and supercedes
any existing instructions concerning my child support direct deposit. I also understand that I have the
responsibility for discontinuing the deposits.
I agree that the Company will have no responsibility for personal checks written against my account, and that
my account will be administered in accordance with the rules and regulations of the Bank.
Petitioner Signature
Please mail form to:
Office of Nikki Alvarez-Sowles, Esq. Office of Nikki Alvarez-Sowles, Esq.
Pasco County Clerk & Comptroller
P.O. Box 338
Pasco County
Clerk & Comptroller
38053 Live Oak Avenue
Dade City, FL 33523-3805
New Port Richey, FL 34656-0338
