ESBD_427816_1749738278261_F.5 Direct Deposit Authorization Form (74-176).pdf

This document is a Direct Deposit Authorization Form from the State of Texas, designed for vendors, individual recipients, or state employees to set up or modify direct deposit payment information. The form allows users to establish new direct deposit accounts, change financial institutions, update account numbers, or cancel existing direct deposit arrangements. It provides comprehensive sections for payee identification, new account information, existing account details, and international payment verification.

The form requires detailed information including financial institution name, routing number, customer account number, account type (checking or savings), and authorization signatures. It includes provisions for both state employees and vendors/recipients, with spaces to enter identification numbers such as Texas Identification Number (TIN), Social Security Number, or Employer Identification Number. The document emphasizes compliance with the National Automated Clearing House Association's rules and provides contact information for state employees, vendors, and state agencies to seek assistance with the direct deposit setup process.