ESBD_395282_1739283199722_SOL_EXH_F.4_25R0007504 936-08_DDA.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 of Texas or modify existing direct deposit information. The form allows for several transaction types including new setup, change of financial institution, change of account number, change of account type, cancellation, and change of custodial agency.

The form requires detailed payee identification including whether they are a state employee or vendor/recipient, their Social Security Number (SSN), Texas Identification Number (TIN), or Employer Identification Number (EIN). It contains sections for new account information including routing number, account number, and account type (checking or savings), as well as verification for international payments. The form must be authorized by the payee's signature and includes sections for state agency use including cancellation reasons and agency contact information. The form emphasizes completion by financial institutions is recommended for new account setups and changes.