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Authorization for Automatic Bank Draft
Please complete this form to for automatic bank draft.
Member Name
First
Middle
Last
Suffix
Sumter EMC Account Number
Member Email Address
Name of Bank
Bank Address
Bank Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Bank Address
Bank Checking Account Number
Bank Transit Number
Checking Account
Savings Account
Upload either a picture or a scanned copy of a voided check.
Upload a Picture of a Voided Check
One file only.
100 MB limit.
Allowed types: gif, jpg, png, svg, jpeg.
Upload Scanned Copy of a Voided Check
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
I agree to the
terms of service
.
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.
Member Signature
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