ESBD_384427_1733781044485_F.5 Direct Deposit Authorization Form (74-176).pdf

This document is a Direct Deposit Authorization Form (Form 74-176) from the State of Texas Comptroller's office, used by vendors, individual recipients, or state employees to receive payments or modify existing direct deposit information. The form consists of eight sections covering transaction types, payee identification, new account information, existing account information, international payments verification, authorization requirements, agency cancellation, and state agency contact details.

The form requires detailed banking information including routing numbers, account numbers, and account types (checking or savings), along with verification for international payments. Financial institution representatives can optionally provide additional verification details. The form includes specific authorization language requiring the payee's signature to allow electronic deposits and compliance with National Automated Clearing House Association rules. For transactions involving international payments, additional documentation (Form 74-227) is required. The form is structured to serve both initial setups and modifications to existing direct deposit arrangements, with separate sections for state agency use in processing cancellations and maintaining contact information.