ESBD_435336_1752519171796_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 establish or modify direct deposit payment information. The form allows users to set up 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 the payee type (state employee or vendor), identification numbers, financial institution details, routing and account numbers, and account type (checking or savings). A critical section requires authorization by the payee, acknowledging that payments will be electronically deposited and that any errors can be reversed by the issuing state agency. The form includes provisions for international payments and spaces for both the payee and state agency to complete necessary information, with specific instructions provided on the second page to guide accurate form completion.