ESBD_445271_1755031369568_EXHIBIT_F.4_Direct Deposit Authorization Form.pdf

This document is a Direct Deposit Authorization form from 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 financial institutions, update account numbers, or cancel existing direct deposit arrangements. It contains multiple sections requiring detailed information including payee identification, banking details, account type (checking or savings), and verification of international payment destinations.

The form mandates comprehensive authorization by requiring the payee's signature to acknowledge understanding of electronic payment procedures, including error correction mechanisms and compliance with the National Automated Clearing House Association's rules. The document provides contact information for different categories of users (state employees, vendors/recipients, and state agencies) to seek assistance in completing the form, with specific guidance for each section. The form also includes a Federal Privacy Act Statement noting that disclosure of identification numbers is required for administration and identification purposes.