Transcription of Illinois Debit MasterCard Payment Option Form
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Illinois Debit MasterCard Payment Option Form
Illinois Debit MasterCard Payment Option FormState of Illinois - Department of Human ServicesIL444-0800 (R-6-10)Page 1 of 1If you chose the Illinois Debit MasterCard Card, we will update our records and you will receive your Illinois Debit MasterCard in the mail. Activate your cardimmediately by calling the toll free number (1-866-338-2944) and follow the instruction on the materials enclosed with your card. Make sure wehave your correct card will not be order to get a Illinois Debit MasterCard :* Attach a copy of your current Driver's License or State card* You MUST fill in all the blanks in the section you are completing (Section 1 to start card use, section 2 to stop card use. )* All information must be clear and readable* Once you choose the Illinois Debit MasterCard your payments will continue on the card until a written cancellation PaymentOption form is received and processed at DHS.
Illinois Debit MasterCard Payment Option Form State of Illinois - Department of Human Services IL444-0800 (R-6-10) Page 1 of 1 If you chose the Illinois Debit MasterCard Card, we will update our records and you will receive your Illinois Debit MasterCard in the mail.
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