ESBD_422211_1747842772589_SOL_EXH_F.5_Direct Deposit Authorization Form (74-176).pdf

This document is a Direct Deposit Authorization Form issued by the State of Texas for vendors, individual recipients, or state employees to set up or modify electronic payment information. The form allows users to establish new direct deposit accounts, change existing account details, or cancel current direct deposit arrangements. The form is comprehensive, covering sections for transaction types, payee identification, new account information, existing account details, international payment verification, and authorization for setup, changes, or cancellation.

The form requires detailed financial information including financial institution name, routing number, customer account number, and account type (checking or savings). It includes provisions for both state employees and vendors/other recipients, with spaces to enter identification numbers such as Texas Identification Number (TIN), Social Security Number, or Employer Identification Number. The form emphasizes the need for accuracy and provides instructions for completing each section, with recommended completion by the financial institution. There are also sections for state agency use in case of cancellation or contact, and a note about contact information for different types of users (state employees, vendors/recipients, and state agencies).