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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