Ohio Child Support Internet Payment Website

DIRECT DEPOSIT APPLICATION
SECTION A - PAYEE INFORMATION
New     Change Request
NAME
First *

Middle

Last *
ADDRESS (PO Box or Street Address) *


Apt. No.
CITY *
STATE/PROVINCE *
  ZIP *
  -
COUNTRY *
Case # *
 
SOC SEC # * (No Dashes)
TELEPHONE # (Incl. Area Code)
() -
SECTION B - FINANCIAL INSTITUTION INFORMATION
FINANCIAL INSTITUTION NAME *
TELEPHONE # (Incl. Area Code)
() -
ADDRESS (PO Box or Street Address)


CITY
STATE/PROVINCE
  ZIP
  -
COUNTRY
ROUTING NUMBER *    
RETYPE ROUTING NUMBER *    
ACCOUNT NUMBER *    
RETYPE ACCOUNT NUMBER *    
TYPE OF ACCOUNT *
 
SECTION C - DIRECT DEPOSIT AUTHORIZATION
I understand this form authorizes the Ohio CSPC to initiate credits and correcting debits to the above account. A debit (withdrawal) to this account will only occur if a credit (deposit) is originated in error. I will receive notification if a debit to my account occurs.
I understand that any request for changes to this authorization must be received at least three (3) business days before the next payment is scheduled to be disbursed to my bank account.
I understand that the availability of funds is dependent on the posting schedule of my bank and it is my responsibility to verify availability.
I understand this agreement will remain in effect until the Ohio CSPC receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Ohio CSPC.

   
* Required Fields.
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