Authorization for Automatic Bank Draft

Please complete this form to for automatic bank draft. 

Member Name
Bank Address
Bank Address
Upload either a picture or a scanned copy of a voided check.
One file only.
100 MB limit.
Allowed types: gif, jpg, png, svg, jpeg.
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
As a conveninece to me (us), I (we) hereby authorize, direct and empower you to pay and charge to my (our) account, checks drawn on my (our) account by Sumter Electric Membership Corporation (utility) and payable to it, provided there are sufficient collected funds in said account to pay the same upon presentation.

I (we) agree that your rights regarding each such check shall be the same as if it were a check drawn on you and signed personally by me (us).

This authority is to remain in effect until revoked by me (us) or the utility and until you actually receive such notice. I (we) agree that you shall be fully protected in honoring any such check.

I (we) further agree that if any such check be dishonored, whether with or without cause and whether intentionally or inadvertently, you shall be under no liability whatsoever.

This authorization shall apply to all existing and future billings for electrical services.

Sign above

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.