ESBD_384451_1733863793841_EXHIBIT F.4 Direct Deposit Authorization Form (74-176).pdf

This 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 from the state of Texas via direct deposit or to modify existing direct deposit information. The form contains eight sections covering transaction types, payee identification, new account information, existing account information, international payments verification, authorization requirements, cancellation procedures, and state agency contact details.

The form requires specific information including the payee's identification (SSN, TIN, or EIN), banking details (routing and account numbers), and authorization signatures. It includes options for setting up new accounts, changing financial institutions, modifying account numbers, or cancelling existing arrangements. The form must be returned to the paying agency at their specified address, and for international payments, additional documentation (Form 74-227) is required if payments will be forwarded to a financial institution outside the United States.