ESBD_395386_1739488275683_SOLICIEXH_F.12_Direct Deposit Authorization Form.pdf

This is a Direct Deposit Authorization Form (Form 74-176) from the State of Texas Comptroller of Public Accounts, used by vendors, individual recipients, or state employees to receive payments from the state of Texas 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 requirements, cancellation procedures, and state agency contact details.

The form requires specific banking information including routing numbers and account numbers, with options for both checking and savings accounts. It includes verification requirements for international payments and mandates authorization signatures from both the payee and state agency representatives. The form provides contact information for different user types: state employees should contact their HR department, vendors/recipients should contact the paying agency's accounts payable staff, and state agencies should contact Fiscal Management Payment Services at 512-936-8138. The form falls under Chapters 552 and 559 of the Government Code and includes privacy protection provisions for Social Security numbers and other sensitive information.