CSSD 04-0008C (Rev. 12/11/18) Alaska Department of Revenue Please Reply To: Child Support Services Division CSS D MS (907) 269-6900 550 W. 7 TH Ave., Suite 310 Anchorage, AK 99501 - 6699 Member-ID: Case-ID(s): EFT Payment Agreement I AGREE to pay $ for monthly child support and $ for arrears payment, for a total of $ by Electronic Funds Transfer (EFT) through a direct withdrawal from my financial accounts (as designated on the attached EFT form) on the day (1st, 5th, 10th, 15th, 20th, or 25th) of the month. I agree that: 1. I will notify my caseworker (by phone and in writing) with any changes to my employment or address. 2. All other enforcement actions will continue. Obligor Signature Date Obligor Printed Name This form must accompany the Non Custodial Parent Direct Withdrawal Authorization 04-0008B form American LegalNet, Inc. www.FormsWorkFlow.com Signature Date Dayphoneform must accompany the Payment Agreement (EFT in lieu of Wage Withholding) 04-0008C form American LegalNet, Inc. www.FormsWorkFlow.com