Illinois Direct Deposit Form 1Illinois Direct Deposit Form 1
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State of Illinois
Department of Employment Security
www.ides.illinois.gov

Direct Deposit Form (Authorization / Modification / Cancellation)
FORM MUST BE COMPLETED IN INK
Claimant Information:
Last Name:
Social Security #:
Claimant Signature:

First Name:

MI:
/

Date:

/

(Este es un documento importante. Si usted necesita un intérprete, póngase en contacto con su oficina local.)
INSTRUCTIONS: If you are applying for Direct Deposit or changing your bank information and want to continue with Direct
Deposit and you are enclosing a voided personal check, check the appropriate box in Section A only and sign above. If you
are not enclosing a voided personal check, check the appropriate box in Section A, sign above, and then have a
representative of your financial institution complete Section B before you return this application to us. If you are discontinuing
Direct Deposit, you only need to check the box in Section C and sign above on this form to cancel.

Mail or Fax