ESBD_452538_1757444827751_F.5 Direct Deposit Authorization Form (74-176).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 direct deposit payment information. The form allows users to establish a new direct deposit account, change financial institutions, change account numbers, or cancel existing direct deposit arrangements. It provides comprehensive sections for payee identification, new account information, existing account details, international payment verification, and authorization for setup, changes, or cancellation.

The form requires detailed information including financial institution details (routing number, account number, account type), payee identification (state employee or vendor), and mandatory authorization signatures. There are specific sections for state agency use in case of cancellation or contact purposes. The document includes instructions on each section, explaining the required information and process. It also includes contact information for state employees, vendors, and state agencies to resolve questions about the direct deposit setup, with a note about the Federal Privacy Act Statement on the second page.