ESBD_439835_1753477450148_SOL_EXH_F.4_405-25R0013322_Direct Deposit Authorization.pdf

This document is a Direct Deposit Authorization form from the State of Texas, specifically issued by the Texas Department of Public Safety (Agency Number 405). The form is designed to enable vendors, individual recipients, or state employees to set up, modify, or cancel direct deposit payment information. The form allows for various transaction types including new setup, changing financial institutions, changing account numbers, and other related modifications to payment routing.

The form requires detailed information such as payee identification, routing numbers, account types (checking or savings), and includes sections for both new account setup and existing account changes. An important verification section asks whether payments will be forwarded to a financial institution outside the United States. The document provides specific return instructions to the Texas Department of Public Safety's Accounts Payable/Direct Deposit Program located at 5805 North Lamar Boulevard in Austin, TX, with a contact phone number of 512-424-2060. The form includes provisions for agency use, authorization signatures, and comprehensive instructions for completion on its second page.