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) that allows vendors, individual recipients, or state employees to receive payments from the state of Texas via direct deposit or modify existing direct deposit information. The form contains multiple sections for transaction types including new setups, changes to financial institutions or account numbers, cancellations, and changes to custodial agencies.

The form requires detailed information including payee identification (SSN, TIN, or EIN), new account information with routing and account numbers, existing account details for changes, and verification regarding international payments. The form must be completed and returned to DPS Accounts Payable/Direct Deposit Program at 5805 North Lamar Boulevard in Austin, TX. The form includes agency contact information showing DPS agency number 405 and a phone number of 512-424-2060. No specific pricing, funding requirements, or contract terms are included as this is purely an administrative document for setting up payment mechanisms.