PA SCDU Direct Deposit Enrollment Form • • • • • • • The payee/check recipient must fill in all the requested information in Section 1. The bank/financial institution must complete Section 2 The payee/check recipient must advise PA SCDU in writing of any account changes in order to remain enrolled in direct deposit. The payee/check recipient’s name, address and Social Security number must match the information on file in the PA Child Support Enforcement System, PACSES. The account where the money is to be deposited must belong to the payee/check recipient of the support order. Mail the completed form to: PA SCDU, PO Box 61216, Harrisburg, PA 17106-1216 Attn: Exceptions Processing Department When PA SCDU receives your direct deposit form and it has been correctly completed, direct deposit will begin in approximately 10 business days. New Enrollment Account Change Cancel Direct Deposit Section 1 (to be completed by payee) Please Print Name of Payee/Check Recipient Type of Depositor Account – check one Street Address O Checking O Savings Depositor checking or savings account number City State Zip Code (daytime) Area Code and Telephone Number PACSES 10 digit member ID number Payee/Joint Payee Certification I certify that I am entitled to the payment identified above and that I have read and understood the above directions to complete this form. In signing this form, I authorize my payments to be sent to the financial institution named below to be deposited to the account designated on this form. Social Security Number Signature Date Section 2 (to be completed by Bank/Financial Institution) Name of Bank/Financial Institution Routing number Account Number Name of Bank Representative Signature of Bank Representative Telephone number/ Date All incomplete or incorrect enrollment forms will be returned to the sender for correction or additions. 12/5/06 American LegalNet, Inc. www.FormsWorkflow.com