ILLINOIS STATE DISBURSEMENT UNIT P.O. Box 5921 Carol Stream, IL 60197-5921 Customer Service: (877) 225-7077

Way2Go Card® Cancellation Form

First Name:
Last Name:
Social Security Number:
Street Address:
City:	State	Zip
Phone Number:

List all the docket numbers to which Way2Go Card® cancellation will apply:

Docket Number

Issuing County or FIPS Code

I, _____________________________, do not want my child support payments to be paid via the Way2Go Card®
MasterCard anymore. I understand that the ILSDU will not  credit any remaining balance in the form of a
check or Direct Deposit. It is my responsibility to clear my balance from this card.

____________________________________________ __________________________

Signature (required to validate this request) Date

Please fax the completed form to (630) 221-2312 or mail to the Illinois State Disbursement Unit at
the address noted above.

If you would like to receive notifications from the State Disbursement Unit that there has been a disbursement on your child support case listed above, please complete the requested information below.

Mobile phone number: __________________              Email: ________________________________

    (Standard Text Messaging rates may apply)                                                        (Please print and write clearly)

Preference (Circle One): Text Message     Email Message

If both mobile phone number and email address are provided but no preference is indicated the notification method will default to email.