ESBD_391236_1737047661825_SOL_EXH_F.4_Direct Deposit Authorization Form.pdf

This is a Direct Deposit Authorization form from the State of Texas, used by vendors, individual recipients, or state employees to receive payments from the state via direct deposit or to modify existing direct deposit information. The form consists of eight sections covering transaction types, payee identification, account information, and authorization requirements.

The form allows for various transaction types including new setups, changes to financial institutions or account numbers, account type changes, and cancellations. It requires detailed information including payee identification (SSN, TIN, or EIN), banking details (routing and account numbers), and verification of international payments. The form must be completed by the payee and includes sections for financial institution information, with optional fields for financial representative details. For state agency use, there are dedicated sections for cancellation reasons and agency contact information. The form includes comprehensive instructions for completion and directs state employees to contact their HR department, vendors to contact accounts payable staff, and state agencies to contact Fiscal Management Payment Services at 512-936-8138 for any questions.