ESBD_389137_1736284832969_SOL_EXH_F.4_DDFORM.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 consists of eight sections covering transaction types, payee identification, new account information, existing account information, international payments verification, authorization for setup/changes/cancellation, cancellation by agency, 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 fields for both checking and savings accounts. It includes provisions for international payment verification and requires authorization signatures from both the payee and agency representatives. The form includes privacy notices and references compliance with Chapters 552 and 559 of the Government Code. Contact information is provided for state employees (Human Resource department), vendors/recipients (accounts payable staff), and state agencies (Fiscal Management, Payment Services at 512-936-8138).