1. COMMISSIONERS
DIANN FILL
CURTIS R. HELFRICH, PE
JAY D. LEIGH
DANA W. LOVE, JR, PE
NICHOLAS J. STROUD
GENERAL MANAGER
KRISTEN J. CHAMPAGNE, PE
SPECIAL PROJECTS ADMINISTRATOR
WILLIAM P. JENKINS
COMPTROLLER
LYNNE T. STONESIFER, CPA
NEW CUSTOMER ADDRESS TRANSFER  GRINDER PUMP ACCOUNT
 NEW CUSTOMER WATER SERVICES $25.00 DESIRED START DATE ____ / ____ / _____
 NEW CUSTOMER SEWER SERVICES $25.00 ACCT # ______________ WORK ORDER # ______________
 OWNER  RENTER  CONTRACTOR
FULL NAME ________________________________________________________________________________________________
IOP SERVICE ADDRESS________________________________________________________________________________________
BILLABLE ADDRESS__________________________________________________________________________________________
CONTACTS
PRIMARY PHONE NO. ( _____ ) _______ - _________ SECONDARY PHONE NO. ( _____ ) _______ - _________
E-MAIL CONTACT(S) _________________________________________________________________________________________
SOCIAL SECURTIY NO. ____________________________________________________________________
DRIVERS LICENSE NO. ____________________________________________________________________
BY SIGNING THIS APPLICATION FOR WATER AND/OR SEWER SERVICE, THE APPLICANT AGREES TO PAY ALL COSTS OF COLLECTION OF THE
APPLICANT’S UNPAID BILLS. THE ISLE OF PALMS WATER AND SEWER COMMISSION HAS THE RIGHT PURSUANT TO THE SOUTH CAROLINA
SETOFF DEBT COLLECTION ACT TO COLLECT ANY SUM DUE AND OWED BY THE APPLICANT THROUGH SETOFF THE APPLICANT’S STATE
INCOME TAX REFUND. IF ISLE OF PALMS WATER AND SEWER COMMISSION CHOOSES TO PURSUE DEBTS OWED BY THE APPLICANT THROUGH
THE SETOFF DEBT COLLECTION ACT, THE APPLICANT AGREES TO PAY ALL FEES AND COSTS INCURRED THROUGH THE SETOFF PROCESS,
INCLUDING FEES CHARGED BY THE DEPARTMENT OF REVENUE, THE SOUTH CAROLINA ASSOCIATION OF COUNTIES, THE MUNICIPAL
ASSOCIATION OF SOUTH CAROLINA, AND THE ISLE OF PALMS WATER AND SEWER COMMISSION. IF THE ISLE OF PALMS WATER AND SEWER
COMISSION APPLICANT AGREES TO PAY THE COST AND FEES ASSOCIATED WITH SELECTED MANNER AS WELL.
FULL NAME _____________________________________________________________________________________________________________
SIGNATURE _______________________________________________________________________________ DATE ______/ _______/ _________
TO BE COMPLETED BY LANDLORD / RENTAL AGENT
I, _____________________________________________________________, ACKNOWLEDGE THAT I AM THE OWNER/RENTAL
AGENT FOR THE PROPERTY AT _______________________________________________________________________AND THAT
_____________________________________________________________________________ IS THE RENTER AT THIS PROPERTY.
SIGNED SIGNATURE _______________________________________________________________ DATE _____/ ______/ _______
OWNER/ RENTAL AGENT MAILING ADDRESS_________________ ____________________________________________________
PRIMARY PHONE NO. ( _____ ) _______ - _________ SECONDARY PHONE NO. ( _____ ) _______ - _________

2. COMMISSIONERS
JOHN J. FERRELL, JR., P.E.
CURTIS R. HELFRICH, P.E.
JAY D. LEIGH
DANA W. LOVE, JR., P.E.
NICHOLAS J. STROUD
GENERAL MANAGER
KRISTEN J. CHAMPAGNE, P.E.
SPECIAL PROJECTS ADMINISTRATOR
WILLIAM P. JENKINS
COMPTROLLER
LYNNE T. STONESIFER, CPA
NEW CUSTOMER TAP FORM ACCT # ____________ WORK ORDER # ________
WATER CHARGES SEWER CHARGES
 NEW CUSTOMER WATER SERVICE $25.00  NEW CUSTOMER SEWER SERVICE $25.00
 WATER TAP FEE 5/8” OR ¾” $ 965.00  SEWER TAP FEE $400.00
 WATER TAP FEE 1” $ 1,105.00
 WATER TAP FEE 1.5” $ 2,240.00
 LARGER 1.5” METER $ ___________
(METER + OTHER MATERIALS COST PLUS)
DROP-IN ONLY (PROVIDING SERVICE LINE IN PLACE)
 5/8” OR ¾” METER $ 320.00
 1” METER $460.00
WATER IMPACT FEE (SEE CHART) $ ___________
SEWER IMPACT FEE (SEE CHART) $ ___________
TOTAL FEES DUE $ __________________________________________
FULL NAME _____________________________________________________________________________________
IOP SERVICE ADDRESS_____________________________________________________________________________
BILLABLE ADDRESS________________________________________________________________________________
PRIMARY PHONE NO. ( ____ ) ______ - ________ SECONDARY PHONE NO. ( ____ ) ____ -_________
E-MAIL CONTACT ________________________________________________________________________________
SOCIAL SECURTIY NO. _____________________________________________________________________________
DRIVERS LICENSE NO. _____________________________________________________________________________
BY SIGNING THIS APPLICATION FOR WATER AND/OR SEWER SERVICE, THE APPLICANT AGREES TO PAY ALL COSTS OF COLLECTION
OF THE APPLICANT’S UNPAID BILLS. THE ISLE OF PALMS WATER AND SEWER COMMISSION HAS THE RIGHT PURSUANT TO THE
SOUTH CAROLINA SETOFF DEBT COLLECTION ACT TO COLLECT ANY SUM DUE AND OWED BY THE APPLICANT THROUGH SETOFF
THE APPLICANT’S STATE INCOME TAX REFUND. IF ISLE OF PALMS WATER AND SEWER COMMISSION CHOOSES TO PURSUE DEBTS
OWED BY THE APPLICANT THROUGH THE SETOFF DEBT COLLECTION ACT, THE APPLICANT AGREES TO PAY ALL FEES AND COSTS
INCURRED THROUGH THE SETOFF PROCESS, INCLUDING FEES CHARGED BY THE DEPARTMENT OF REVENUE, THE SOUTH
CAROLINA ASSOCIATION OF COUNTIES, THE MUNICIPAL ASSOCIATION OF SOUTH CAROLINA, AND THE ISLE OF PALMS WATER AND
SEWER COMMISSION. IF THE ISLE OF PALMS WATER AND SEWER COMISSION APPLICANT AGREES TO PAY THE COST AND FEES
ASSOCIATED WITH SELECTED MANNER AS WELL.
FULL NAME _____________________________________________________________________________________________________________
SIGNATURE _______________________________________________________________________________ DATE ______/ _______/ _________
**ALL SEWER TAPS MUST BE INSPECTED BY A REPRESENTATIVE OF THE ISLE OF PALMS WATER AND
SEWER COMMISSION DURING TAP IN. A 24-HOUR NOTICE IS REQUIRED FOR SEWER TAP INSPECTIONS. **
OWNER/CONTRACTOR PRINTED NAME _______________________ ____________________________________________________
SIGNED SIGNATURE _______________________________________________________________ DATE _____/ ______/ ____
WATER AND SEWER IMPACT FEES BASED ON SQUARE FOOTAGE
SQUARE FOOTAGE WATER SEWER
2,000 OR LESS $2,400.00 $2,500.00
2,001 TO 3,500 $3,700.00 $3,800.00
GREATER THAN 3,500 $5,500.00 $5,700.00
*FEES WILL BE LEVIED WHEN THE SYSTEM IS IMPACTED
BY A CUSTOMER CONNECTING TO THE SYSTEM OR
INCREASING THE SIZE OF THE RESIDENCE.

3. COMMISSIONERS
DIANN FILL
CURTIS R. HELFRICH, PE
JAY D. LEIGH
DANA W. LOVE, JR, PE
NICHOLAS J. STROUD
GENERAL MANAGER
KRISTEN J. CHAMPAGNE, PE
SPECIAL PROJECTS ADMINISTRATOR
WILLIAM P. JENKINS
COMPTROLLER
LYNNE T. STONESIFER, CPA
NEW CUSTOMER FIRE LINE / FIRE TAP
 NEW CUSTOMER FIRE LINE SERVICES $25.00 ACCT # ____________ WORK ORDER # ________
 WATER TAP FEE 1” $ 818.00
 WATER TAP FEE 1.5” $ 1,043.00
 LARGER THAN 1.5” $ ___________ (METER + OTHER MATERIALS COST PLUS)
TOTAL FEES DUE $ ___________
FULL NAME _____________________________________________________________________________________
IOP SERVICE ADDRESS_____________________________________________________________________________
BILLABLE ADDRESS________________________________________________________________________________
CONTACTS
PRIMARY PHONE NO. ( ____ ) ______ - ________ SECONDARY PHONE NO. ( ____ ) ____ -_________
E-MAIL CONTACT ________________________________________________________________________________
SOCIAL SECURTIY NO. _____________________________________________________________________________
DRIVERS LICENSE NO. _____________________________________________________________________________
BY SIGNING THIS APPLICATION FOR WATER AND/OR SEWER SERVICE, THE APPLICANT AGREES TO PAY ALL COSTS OF
COLLECTION OF THE APPLICANT’S UNPAID BILLS. THE ISLE OF PALMS WATER AND SEWER COMMISSION HAS THE
RIGHT PURSUANT TO THE SOUTH CAROLINA SETOFF DEBT COLLECTION ACT TO COLLECT ANY SUM DUE AND OWED
BY THE APPLICANT THROUGH SETOFF THE APPLICANT’S STATE INCOME TAX REFUND. IF ISLE OF PALMS WATER AND
SEWER COMMISSION CHOOSES TO PURSUE DEBTS OWED BY THE APPLICANT THROUGH THE SETOFF DEBT
COLLECTION ACT, THE APPLICANT AGREES TO PAY ALL FEES AND COSTS INCURRED THROUGH THE SETOFF
PROCESS, INCLUDING FEES CHARGED BY THE DEPARTMENT OF REVENUE, THE SOUTH CAROLINA ASSOCIATION OF
COUNTIES, THE MUNICIPAL ASSOCIATION OF SOUTH CAROLINA, AND THE ISLE OF PALMS WATER AND SEWER
COMMISSION. IF THE ISLE OF PALMS WATER AND SEWER COMISSION APPLICANT AGREES TO PAY THE COST AND FEES
ASSOCIATED WITH SELECTED MANNER AS WELL.
FULL NAME _____________________________________________________________________________________________________________
SIGNATURE _______________________________________________________________________________ DATE ______/ _______/ _________

4. COMMISSIONERS
DIANN FILL
CURTIS R. HELFRICH, PE
JAY D. LEIGH
DANA W. LOVE, JR, PE
NICHOLAS J. STROUD
GENERAL MANAGER
KRISTEN J. CHAMPAGNE, PE
SPECIAL PROJECTS ADMINISTRATOR
WILLIAM P. JENKINS
COMPTROLLER
LYNNE T. STONESIFER, CPA
AUTHORIZATION OF THIS FORM ALLOWS THE ISLE OF PALMS WATER & SEWER COMMISSION TO DRAFT YOUR MONTHLY BILLS FROM A
DESIGNATED CHECKING OR SAVINGS ACCOUNT ONCE A MONTH. YOU WILL RECEIVE A POSTCARD BILL IN THE MAIL AT THE BEGINNING
OF EVERY MONTH SHOWING THE BREAK DOWN OF CHARGES. UPON RECEIVING YOUR BILL PLEASE CONTACT OUR OFFICE IN THE EVENT
THAT CHARGES APPEAR INCORRECT TO ENSURE THE CORRECT AMOUNT WILL BE DEBITED. IF YOU CHOOSE TO APPLY, WE WILL DEBIT
YOUR ACCOUNT MONTHLY ON OR AROUND THE DUE DATE OF THE BILL. WE CANNOT GUARANTEE THE EXACT DATE THAT YOUR
ACCOUNT WILL BE DEBITED SINCE SOME DUE DATES FALL ON WEEKENDS OR FEDERAL BANK HOLIDAYS.
ISLE OF PALMS WATER & SEWER COMMISSION
DR AFT A UT HORI Z ATI ON AG R EE MENT
I AUTHORIZE THE ISLE OF PALMS WATER & SEWER COMMISSION TO DRAFT MY MONTHLY BILL PAYMENT FROM THE
DESIGNATED BANK ACCOUNT LISTED BELOW. I UNDERSTAND THAT THIS AUTHORIZATION WILL BE IN EFFECT UNTIL I
NOTIFY THE ISLE OF PALMS WATER & SEWER COMMISSION IN WRITING, WHEN I NO LONGER REQUIRE THIS SERVICE.
I UNDERSTAND THAT THE ISLE OF PALMS WATER & SEWER COMMISSION MAY IMPOSE A DELINQUENT FEE IN THE EVENT
THAT THE BANK DOES NOT PAY THE ENTIRE MONTHLY PAYMENT.
FULL NAME _________________________________________________________________________________________________
IOP SERVICE ADDRESS_________________________________________________________________ ACCT NO. ______________
BILLABLE ADDRESS___________________________________________________________________________________________
PRIMARY PHONE NO. ( _____ ) _______ - _________ SECONDARY PHONE NO. ( _____ ) _______ - _________
E-MAIL CONTACT(S) __________________________________________________________________________________________
BANK NAME ________________________________________________________________________________________________
CHECK WHICH TYPE OF ACCOUNT THIS IS  SAVINGS  CHECKING
ENCLOSE AND/OR ATTACH COPY OR VOIDED CHECK TO THIS FORM FOR TRANSIT # AND ACCOUNT INFORMATION
______________________________________________________ _____/ _____/ _____
AUTHORIZED SIGNATURE DATE
ATTACH CHECK BELOW

5. THE ISLE OF PALMS WATER & SEWER COMMISSION
ISLE OF PALMS, SOUTH CAROLINA
______________________________________________________________________________________
OATH OF OFFICE
Tuesday, January 5, 2015
I, ____________________________________________, having been appointed as a Commissioner of the Isle of Palms Water & Sewer
Commission (IOPWSC), do solemnly swear (or affirm) that I am duly qualified, according to the Constitution of this
State, to exercise the duties of the office to which I have been elected and that I will, to the best of my ability, discharge the
duties thereof, and preserve, protect, and defend the Constitution of this State and of the United States of America.
As Commissioner of the Isle of Palms Water and Sewer Commission, I will equally, fairly and impartially, to the best of
my ability and skill, exercise the trust reposed in me, and will use my best endeavor to preserve the peace and carry into
effect, according to the law, the purposes for which I have been elected. So help me God.
__________________________________________________________________
IOPWSC Commissioner
Subscribed and sworn to before me,
this ________________ day of __________________ AD, ______________.
__________________________________________________________________
Marie Copeland, Isle of Palms City Clerk