ESBD_450733_1756821041378_SOL_EXH_F.4_Direct Deposit Authorization Form (74-176).pdf

This document is a Direct Deposit Authorization form from the State of Texas for setting up, changing, or canceling direct deposit payment information. The form is designed for state employees, vendors, or other recipients to provide or update their banking details for receiving payments from Texas state agencies. It requires comprehensive information including payee identification, financial institution details, routing and account numbers, and authorization signatures. The form covers various transactions such as new account setup, changing financial institutions, modifying account numbers, and international payment verifications.

The form includes sections for both the payee and the state agency to complete, with fields for identification numbers, contact information, account types (checking or savings), and verification of payment destinations. There are optional fields for financial representative information and mandatory sections requiring authorized signatures. The document provides instructions for each section and includes contact information for state employees, vendors, and state agencies to seek assistance with completing the form. A Federal Privacy Act Statement is referenced, indicating that certain personal information is required for administrative and identification purposes.