ESBD_396274_1739551244401_SOL_EXH_F.4_24R0026045 909-63_DDA.pdf

This is a Direct Deposit Authorization form from the State of Texas Comptroller of Public Accounts, used by vendors, individual recipients, or state employees to receive payments or modify existing direct deposit information. The form allows for several transaction types including new setup, changes to financial institutions or account numbers, account type changes, cancellations, and changes to custodial agency.

The form requires detailed payee identification information including SSN, TIN, or EIN, along with complete banking information such as routing numbers and account numbers for either checking or savings accounts. It includes sections for both new account setup and existing account modifications. The form requires verification regarding international payments and contains mandatory authorization language for the setup, changes, or cancellation of direct deposit arrangements. Additional sections are included for state agency use, including areas for cancellation reasons and agency contact information.