Fourth Circuit Solicitor

William B. Rogers, Jr.

Check Unit Worksheet

Check Writer / Offender Information (Obtained At Time Check Was Accepted)

(Mailing Address Can Be Same As Physical Address) (Mailing City / State / Zip Can Be Same As Physical City / State / Zip)

The following section must be completed with the victim information.

Please Read

I could be held liable for the $91 in fees outlined in the S.C. Code of Laws Section 17-22-710 if I:

  • Withdraw the check from the program
  • Stop the prosecution process
  • Accept full or partial payment on this check which could result in the collection or prosecution process being stopped

By signing this form, I swear that the above is true.

Thank you for taking the time to complete and submit the Check Unit Worksheet. An informative confirmation email will be sent to the email address you provided above. Confirm the email address is correct before submitting and be sure to check your spam/junk folder for the email confirmation. Please email a scanned copy or photo copy of the worthless check, along with any documents from the financial institution, to Thank you.