Payor Electronic Funds Transfer Change Form
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Payor Electronic Funds Transfer Change Form. This is a Indiana form and can be use in Marion Local County.
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Tags: Payor Electronic Funds Transfer Change Form, Indiana Local County, Marion
Marion County Clerk’s Office
Accounting Department
200 East Washington Street, W-123
Indianapolis, IN 46204
Fax (317) 327-4813
www.indy.gov/clerk
Phone (317) 327-8090
PAYOR ELECTRONIC FUNDS TRANSFER CHANGE FORM
I would like to change/close my Electronic Funds Transfer account starting:
CHECK THE APPROPRIATE OPTIONS:
(1)
Change Electronic Funds Transfer Account to:
(a)
Savings
Bank & Account #
(b)
Checking
Bank & Account #
(2)
Close my account.
(3)
Change my amount from $
(4)
Other (explain)
to $
(Print Name)
(Signature)
(Address)
(Social Security #)
(Date)
(City, State, Zip )
(Day Time Phone #)
(E-mail)
Payor: This form must be presented to the Clerk’s office 10 business days before the next scheduled transaction to be effective. Change of accounts will
take 10 business days or more to be active. Any payments due on your account during that period must be paid at our Child Support payment windows.
(initials)
Please include a valid federal or state picture ID when returning this form.
For Office Use only:
Changes
Rev 4-09
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