ESBD_393686_1738337626949_F.5 Direct Deposit Authorization Form (74-176).pdf

This is a Direct Deposit Authorization Form (74-176) from the State of Texas Comptroller's office, used by vendors, individual recipients, or state employees to receive payments or modify existing direct deposit information. The form includes sections for transaction types (new setup, changes to financial institutions, account numbers, or cancellations), payee identification, and account information setup.

The form requires detailed banking information including routing numbers and account numbers for both checking and savings accounts, with space for financial institution representatives' information. It includes verification for international payments and requires authorization signatures from both the payee and state agency representatives. The form must be returned to the appropriate paying agency, with specific instructions for state employees to contact their HR department, vendors/recipients to contact the paying agency's accounts payable staff, and state agencies to contact Fiscal Management Payment Services at 512-936-8138.