ESBD_443562_1754505714801_SOL_EXH_F.4_Direct Deposit Authorization Form.pdf

This is a Texas state Direct Deposit Authorization form (Form 74-176) used by vendors, individual recipients, or state employees to establish direct deposit payments from the State of Texas or to modify existing direct deposit arrangements. The form provides options for various transaction types including new account setups, changes to financial institutions, account numbers, account types, and cancellations, with specific sections designated for state agency use versus general payee use.

The form requires comprehensive payee identification information including Social Security numbers, Texas Identification Numbers, or Individual Taxpayer Identification Numbers, along with complete banking details such as routing numbers, account numbers, and account types (checking or savings). It includes verification requirements for international payments, authorization signatures from both payees and state agency representatives, and specific procedures for cancellation by agencies. The form incorporates privacy protections under federal law and provides contact information for questions regarding state employees, vendors/recipients, and state agencies, with return instructions directing completed forms back to the appropriate paying agency.