Menu HomeNCP LoginPrivacy PolicySecurityFAQ'sCustodial ParentNon Custodial ParentEmployerEmployer EFT/EDI PacketNACHA's User Guide for Electronic Child Support Payments
Colorado Family Support Registry Internet Payment Website

DIRECT DEPOSIT APPLICATION
SECTION A - PAYEE INFORMATION
New     Change Request     Cancel
NAME
First *
Middle
Last *
ADDRESS (PO Box or Street Address) *


Apt. No.
CITY *
STATE/PROVINCE *
  ZIP *
  - 		COUNTRY *
FSR#* Enter your ten-digit FSR account number including leading zeros. If you have multiple FSR numbers, just enter one. Your application will apply to all of your FSR numbers.
   
SOC SEC # * (No Dashes)
TELEPHONE # (Incl. Area Code)
() -
SECTION B - FINANCIAL INSTITUTION INFORMATION
FINANCIAL INSTITUTION NAME *
TELEPHONE # (Incl. Area Code)
() -
ADDRESS (PO Box or Street Address)


CITY
STATE/PROVINCE
  ZIP
  - 		COUNTRY
ROUTING NUMBER *    
RETYPE ROUTING NUMBER *    
ACCOUNT NUMBER *    
RETYPE ACCOUNT NUMBER *    
TYPE OF ACCOUNT *
 
SECTION C - DIRECT DEPOSIT AUTHORIZATION
I understand this form authorizes the Family Support Registry to initiate credits and correcting debits to the above account. A debit (withdrawal) to this account will only occur if a credit (deposit) is originated in error. I will receive notification if a debit to my account occurs.
I understand that any request for changes to this authorization must be received at least three (3) business days before the next payment is scheduled to be disbursed to my bank account.
I understand that the availability of funds is dependent on the posting schedule of my bank and it is my responsibility to verify availability.

   
* Required Fields.
 Please read our Terms and Conditions and our Accessibility Statement.