North Carolina Child Support

Payee Name: Payee Bank ID:
Payee ID: Payee Bank Acct. No.:
Case Identifier:                           Company Entry Description:
Absent Parent Name:  :  
Absent Parent SSN:        
Medical Support: Employment Termination:    

                Payment Amount:

                        FIPS Code:    
Pay Date:  Start Date:     
                               
     Create Prenote:    Hold Transfer:     
           
Prenote Date:        
                                         Last Payment Date: