Utilities Bank Draft Payment Application

Use this form to apply for automatic bank draft payment of your City of Hartsville Utility bill. You will need a voided check and your utility account number, which can be found on your utility bill, to submit this form.

If accepted, payment will be automatically drafted from the indicated bank account on the 15th of the month or the next business day. Contact utilities@hartsvillesc.gov or call 843.383.3015 if you have any questions about this application.

This form is also available as a downloadable PDF file.

Bank Account Information
Utility Account Information
Acknowledgement & Certification

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Application Date *

Bank Information

Bank Name *

Bank Address *

Bank Address

City

State/Province

Zip/Postal

Refer to the example image below to locate the bank routing and account numbers on your check. You don't need to enter a check number in this form.

Name on Bank Account *

Please enter the account name as it appears on your check or statement.

Bank Routing Number *

Please enter the bank's routing number as it appears on your check.

Bank Account Number *

Please enter your bank account number as it appears on your check.

It appears that you may have entered either the example routing, checking, or check number from the image above. Please enter the routing and checking numbers as they appear on an actual check for the checking account you would like to use for draft payments on your utility account.

Voided Check Image *

Maximum file size: 8.39MB

For verification, please upload an image of a voided a check for the checking account you would like to use for draft payments on your utility account.

If you are human, leave this field blank.

The Utilities Bank Draft Payment Application is also available as a downloadable PDF.