ESBD_392438_1737673805007_SOLICIEXH_F.4_Direct Deposit Authorization Form.pdf

This is a Direct Deposit Authorization form from the State of Texas Comptroller's office (Form 74-176) 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 contains eight sections covering transaction types, payee identification, new account information, existing account information, international payments verification, authorization for setup/changes/cancellation, agency cancellation, and state agency contact details.

The form requires specific financial institution details including routing numbers, account numbers, and account types (checking or savings). It includes verification requirements for international payments and contains authorization language regarding electronic deposits and compliance with National Automated Clearing House Association rules. For assistance, state employees are directed to contact their HR department or payroll staff, vendors/recipients should contact the paying agency's accounts payable staff, and state agencies should contact Fiscal Management Payment Services at 512-936-8138.