ESBD_382112_1730838528620_SOL_EXH_F.4_405-25R0003545_Direct Deposit Authorization.pdf

This is a Direct Deposit Authorization form (Form 74-176) from the Texas Department of Public Safety (DPS) used for vendors, individual recipients, or state employees to receive payments from the State of Texas. The form allows for new direct deposit setups, changes to existing account information, or cancellations of direct deposit arrangements. The form is associated with a contract opportunity for microscope maintenance services (Solicitation #405-25R0003545) and would be required for payment processing for the awarded vendor.

The form contains multiple sections including transaction types, payee identification, new account information, existing account information, international payments verification, and authorization requirements. The form must be returned to the DPS Accounts Payable/Direct Deposit Program at 5805 North Lamar Boulevard in Austin, TX. The form requires standard banking information including routing numbers, account numbers, and financial institution details, as well as the payee's tax identification information (SSN, TIN, or EIN). The agency number listed on the form is 405, corresponding to the Texas Department of Public Safety.