ESBD_389137_1736284832969_SOL_EXH_F.4_DDFORM.pdf

This is a Direct Deposit Authorization form from the State of Texas Comptroller's office, used for vendors, individual recipients, or state employees to receive payments or modify existing direct deposit information. The form (Form 74-176) allows for various transaction types including new setups, changes to financial institutions or account numbers, account type changes, cancellations, and custodial agency changes.

The form requires detailed payee identification including whether they are a state employee or vendor, tax identification numbers (SSN, TIN, or EIN), and complete contact information. For new accounts, it requires banking information including routing numbers, account numbers, and account types (checking or savings). The form also includes verification for international payments and requires authorization signatures from both the payee and state agency representatives. This document directly relates to the payment processing requirements for the headset procurement opportunity, as vendors must establish or verify direct deposit capabilities to receive payment from the Texas Department of Public Safety.