(740 ILCS 170/2.2) (from Ch. 48, par. 39.2b)
    Sec. 2.2. Forms; notice of intent to assign wages; revocation.
    (a) The notice to an employee required by Section 2 shall be in the following form:
"NOTICE OF INTENT TO ASSIGN WAGES
    This notice is required by the Illinois Wage Assignment Act. The notice has been sent to tell you that a creditor (name and address listed below) plans to have your wages assigned. A wage assignment is a document you signed at the time you signed the contract for your debt. It authorizes your creditor to receive a portion of your wages directly from your employer, in order to pay your debt. This notice contains important information about the debt and what your options are. You should read the entire notice carefully.
WHY THE CREDITOR WANTS TO ASSIGN YOUR WAGES
    You signed a wage assignment on ....... (date) ....... The wage assignment was signed as security if you failed to make payment on the contract you signed on ......... (date) .......... A copy of the wage assignment is attached. The creditor's records show that you have not made a payment since ......... (date) ....... and that you now owe $........ on the contract. The creditor will send a demand for wages to your employer 20 days from the date you receive this.
    The creditor's name, address, and phone number are:
......................
......................
......................
......................
(Signed by)"
    (b) If the wage assignment is revocable under federal law, the notice required under subsection (a) shall also include the following:
UNDERSTANDING YOUR CHOICES UNDER THE
ILLINOIS WAGE ASSIGNMENT ACT
    There are options available to you in this process. You should consider your options and determine the one that is best for you. You have the right to contact an attorney at any point concerning the wage assignment, or to help you determine your best option.
    Your options include:
        (1) You can stop the wage assignment at any time,
    
which will stop your wages from being deducted. It will not eliminate your debt, and interest may continue to accrue. You may contact your creditor for more information about the interest rate on your contract, and to determine how much interest might accrue if you stop the wage assignment.
        Your creditor will still be able to pursue other
    
means of collecting any debt you may owe, including filing a lawsuit against you for the full amount owed under the contract and any interest that might accrue. A lawsuit might result in you owing legal fees and other costs.
        You can stop the wage assignment by filling out the
    
enclosed Revocation Notice Form, or by writing a letter stating that you are revoking the wage assignment. Send the Revocation Notice Form or letter by registered or certified mail to the creditor, at the address listed above. It is highly recommended that you give a copy of the Revocation Notice Form or letter to your employer so your employer can stop any pending payments.
        If you choose to write a letter, it should be
    
addressed to the creditor, and should include:
            (i) your name;
            (ii) the account number; and
            (iii) a statement that you are revoking the wage
        
assignment, such as, "I am revoking the wage assignment."
        Even if the wage assignment has already begun, you
    
can still stop it now or at any point in the future.
        (2) You can do nothing, and allow the wage assignment
    
process to proceed. Starting in 20 days, part of your wages will be sent directly to the creditor to pay off your debt. This will reduce your take-home pay every pay period until the total amount of the debt is repaid.
        Up to 15% of your wages will be sent to the creditor
    
every pay period. Once the total amount is repaid, the creditor will send a notice to you and to your employer that includes the creditor's name, your name, and the account number, stating that the wage assignment is closed and no further wages should be assigned.
        (3) You can contact your creditor to repay the debt,
    
or to explore other options, including a repayment plan or refinancing, if available. You can contact your creditor at the address and phone number listed above.
        If you agree on another repayment option with your
    
creditor, the creditor will send a notice to your employer stating that your wages should not be assigned.
    (c) If the wage assignment is revocable under federal law, the notice required under subsection (b) shall be accompanied by the following Revocation Notice Form, with the relevant information inserted by the creditor:
"REVOCATION NOTICE
The employee's name and address are:
......................
......................
......................
......................
The creditor's name and address are:
......................
......................
......................
......................
Re: (insert account number)
    I, (insert name), hereby revoke the wage assignment I signed on (insert date the wage assignment was signed). You no longer have my permission to use this wage assignment.
 
......................    ......................
(Signed by)               (Date)"
(Source: P.A. 99-903, eff. 1-1-17.)