ESBD_387119_1734712785779_SOL_EXH_F.4_405-25R0003361_910-65_Deposit.pdf

This is a Direct Deposit Authorization form from the State of Texas used by vendors, individual recipients, or state employees to receive payments or 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, agency cancellation, and state agency contact details. No specific response dates or contract terms are included as this is a standard administrative form.

The form requires detailed banking information including routing numbers and account numbers, with options for both checking and savings accounts. It includes verification requirements for international payments and requires authorization signatures from both the payee and state agency representatives. The form includes privacy notices and references compliance with Chapters 552 and 559 of the Government Code. For assistance, state employees are directed to contact their Human Resource department, vendors/recipients should contact the paying agency's accounts payable staff, and state agencies should contact Fiscal Management Payment Services at 512-936-8138.