Who is completing the application? (required) Tenant Owner Management Company/Agent (puts account in your company name) Account Holder Information Acct Holder Name (required) SS# or FEIN# (required) DL State/# (required) Drivers License image upload (required) Files must be less than 16 MB.Allowed file types: gif jpg jpeg png. Contact Phone # Email address Place of employement (required) Would you like to add a co-applicant? Yes No Co-Applicant Information Co-Applicant Name (required) DL State/# (required) Drivers License image upload (required) Files must be less than 16 MB.Allowed file types: gif jpg jpeg png. SS# or FEIN# (required) Contact Phone # Email address Place of employement New Service Address (required) Date to begin service (required) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032 New built home- please provide SUBDIVISION/DEVELOPMENT NAME New built home- please provide LOT # Billing Addressthis is where we will send statements Address (required) City (required) State (required) Zip (required) Previous Service Address (IF on Berkeley County Water/Sewer) Previous Service Street Address City State Zip Date to Close Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032 Land Owner Name if renting (required) Land Owner Address (required) Land Owner Name if renting (required) Land Owner Address (required) Account Holder Signature By signing this application for water sewer service, applicant(s) has read and agrees to the Water and Sewer Service Terms and Conditions; and acknowledgesinformation provided above is true and accurate to the best of the applicant’s knowledge. note: A Security Deposit of $50.00 for water and $125.00 for sewer is required to complete this process Leave this field blank