Application for Service
PO Box 398 • Indiantown • FL • 34956
Phone (772) 597- 2121 • Fax (772) 597-4155
This form can be mailed, faxed or emailed to Customer Service at the address or fax number above.
All orders for service must be received at least two days prior to date of service.
Water & Sewer
Water Only
Sewer Only
Activation Date:
Activation Time:
Tenant (Lease Required)
Agent (Listing Agreement)
New Construction
Applicant Name:
Business Name (DBA):
Contact Name:
Service Address:
Mailing/Billing Address:
Home Phone:
Cell Phone:
Issued By:
Employer Name:
Employer Phone:
Do you currently have or have previously had water service with Indiantown Company?
If yes, please list account # or service address:
Does Service Need to be disconnected at this address?
If yes, what date should service be disconnected?
Service Type:
5/8 x 3/4
8” Turbo
Private Fire Protection
A deposit is required for connection of service.
$125.00 Sewer
Connect Charge $50.00 (after 4pm $150.00)
Connect Charge $50.00 (after 4pm $150.00)
2.0" Meter and Larger:
Determined on a case by case basis
Connect Charge
Deposits will be applied to the account after 24 consecutive on time payments. Upon discontinuation of service any deposit
on file will be applied to the account; any remaining credit balance will be refunded to the above listed applicant within 90 days.
Deposit is non-transferable.
I hereby request The Village of Indiantown to supply services at the above listed address until receipt of formal notice from me
requesting discontinuance of such service.
I agree to pay for service by the 20
of each month at the rates established by The Village of Indiantown. I understand that non-payment
of charges will result in disconnection of service and assessment of reconnect charges and late fees.
Printed Name
VOI Use Only
Billing Account Number:
Meter Account Number:
Meter #:
Meter Reading:
CSR Name:
1.0 GENERAL INFORMATION - These Rules and Regulations are a part of the rate schedules and applications and contracts of the Company and, in the absence of specific written agreement
to the contrary, apply without modifications or change to each and every Customer to whom the Company renders water service.
The Company shall provide water service to all Customers requiring such service within its Certificated territory pursuant to Chapter 25-30, Florida Administrative Code and Chapter 367,
Florida Statutes.
2.0 POLICY DISPUTE - Any dispute between the Company and the Customer or prospective Customer regarding the meaning or application of any provision of this tariff shall upon written
request by either party be resolved by the Florida Public Service Commission.
3.0 APPLICATION - In accordance with Rule 25-30.310, Florida Administrative Code, a signed application is required prior to the initiation of service. The Company shall provide each Applicant
with a copy of the brochure entitled “Your Water and Wastewater Service,” prepared by the Florida Public Service Commission.
4.0 APPLICATIONS BY AGENTS - Applications for water service requested by firms, partnerships, associations, corporations, and others shall be rendered only by duly authorized parties or
5.0 REFUSAL OR DISCONTINUANCE OF SERVICE - The Company may refuse or discontinue water service rendered under application made by any member or agent of a household,
organization, or business in accordance with Rule 25-30.320, Florida Administrative Code.
6.0 EXTENSIONS - Extensions will be made to the Company's facilities in compliance with Commission Rules and Orders and the Company's tariff.
7.0 TYPE AND MAINTENANCE - In accordance with Rule 25-30.545, Florida Administrative Code, the Customer's pipes, apparatus and equipment shall be selected, installed, used and
maintained in accordance with standard practice and shall conform with the Rules and Regulations of the Company and shall comply with all laws and governmental regulations applicable
to same. The Company shall not be responsible for the maintenance and operation of the Customer's pipes and facilities. The Customer expressly agrees not to utilize any appliance or
device which is not properly constructed, controlled and protected or which may adversely affect the water service. The Company reserves the right to discontinue or withhold water service
to such apparatus or device.
8.0 DELINQUENT BILLS - When it has been determined that a Customer is delinquent in paying any bill, water service may be discontinued after the Company has mailed or presented a
written notice to the Customer in accordance with Rule 25-30.320, Florida Administrative Code.
9.0 CONTINUITY OF SERVICE - In accordance with Rule 25-30.250, Florida Administrative Code, the Company will at all times use reasonable diligence to provide continuous water service
and, having used reasonable diligence, shall not be liable to the Customer for failure or interruption of continuous water service.
If at any time the Company shall interrupt or discontinue its service, all Customers affected by said interruption or discontinuance shall be given not less than 24 hours written notice.
10.0 LIMITATION OF USE - Water service purchased from the Company shall be used by the Customer only for the purposes specified in the application for water service. Water service shall
be rendered to the Customer for the Customer's own use and the Customer shall not sell or otherwise dispose of such water service supplied by the Company.
In no case shall a Customer, except with the written consent of the Company, extend his lines across a street, alley, lane, court, property line, avenue, or other way in order to furnish water
service to the adjacent property through one meter even though such adjacent property may be owned by him. In case of such unauthorized extension, sale, or disposition of service, the
Customer's water service will be subject to discontinuance until such unauthorized extension, remetering, sale or disposition of service is discontinued and full payment is made to the
Company for water service rendered by the Company (calculated on proper classification and rate schedules) and until reimbursement is made in full to the Company for all extra expenses
incurred for clerical work, testing, and inspections. (This shall not be construed as prohibiting a Customer from remetering.)
11.0 CHANGE OF CUSTOMER'S INSTALLATION - No changes or increases in the Customer's installation, which will materially affect the proper operation of the pipes, mains, or stations of the
Company, shall be made without written consent of the Company. The Customer shall be liable for any charge resulting from a violation of this Rule.
12.0 PROTECTION OF COMPANY'S PROPERTY - The Customer shall exercise reasonable diligence to protect the Company's property. If the Customer is found to have tampered with any
Company property or refuses to correct any problems reported by the Company, service may be discontinued in accordance with Rule 25-30.320, Florida Administrative Code.
In the event of any loss or damage to property of the Company caused by or arising out of carelessness, neglect, or misuse by the Customer, the cost of making good such loss or repairing
such damage shall be paid by the Customer.
13.0 INSPECTION OF CUSTOMER'S INSTALLATION - All Customer's water service installations or changes shall be inspected upon completion by a competent authority to ensure that the
Customer's piping, equipment, and devices have been installed in accordance with accepted standard practice and local laws and governmental regulations. Where municipal or other
governmental inspection is required by local rules and ordinances, the Company cannot render water service until such inspection has been made and a formal notice of approval from the
inspecting authority has been received by the Company.
Not withstanding the above, the Company reserves the right to inspect the Customer's installation prior to rendering water service, and from time to time thereafter, but assumes no
responsibility whatsoever for any portion thereof.
14.0 ACCESS TO PREMISES - In accordance with Rule 25-30.320(2)(f), Florida Administrative Code, the Customer shall provide the duly authorized agents of the Company access at all
reasonable hours to its property. If reasonable access is not provided, service may be discontinued pursuant to the above rule.
15.0 RIGHT-OF-WAY OR EASEMENTS - The Customer shall grant or cause to be granted to the Company, and without cost to the Company, all rights, easements, permits, and privileges which
are necessary for the rendering of water service.
16.0 CUSTOMER BILLING - Bills for water service will be rendered - Monthly, Bimonthly, or Quarterly - as stated in the rate schedule.
In accordance with Rule 25-30.335, Florida Administrative Code, the Company may not consider a Customer delinquent in paying his or her bill until the twenty-first day after the Company
has mailed or presented the bill for payment.
A municipal or county franchise tax levied upon a water or wastewater public Company shall not be incorporated into the rate for water or wastewater service but shall be shown as a separate
item on the Company's bills to its Customers in such municipality or county.
If a Company utilizes the base facility and usage charge rate structure and does not have a Commission authorized vacation rate, the Company shall bill the Customer the base facility charge
regardless of whether there is any usage.
17.0 TERMINATION OF SERVICE - When a Customer wishes to terminate service on any premises where water service is supplied by the Company, the Company may require reasonable
notice to the Company in accordance with Rule 25-30.325, Florida Administrative Code.
18.0 PAYMENT OF WATER AND WASTEWATER SERVICE BILLS CONCURRENTLY - In accordance with Rule 25-30.320(2)(g), Florida Administrative Code, when both water and wastewater
service are provided by the Company, payment of any water service bill rendered by the Company to a Customer shall not be accepted by the Company without the simultaneous or
concurrent payment of any wastewater service bill rendered by the Company.
19.0 UNAUTHORIZED CONNECTIONS - WATER - Any unauthorized connections to the Customer's water service shall be subject to immediate discontinuance without notice, in accordance
with Rule 25-30.320, Florida Administrative Code.
20.0 METERS - All water meters shall be furnished by and remain the property of the Company and shall be accessible and subject to its control, in accordance with Rule 25-30.230, Florida
Administrative Code.
21.0 ALL WATER THROUGH METER - That portion of the Customer's installation for water service shall be so arranged to ensure that all water service shall pass through the meter. No
temporary pipes, nipples or spaces are permitted and under no circumstances are connections allowed which may permit water to by-pass the meter or metering equipment.
22.0 ADJUSTMENT OF BILLS - When a Customer has been undercharged as a result of incorrect application of the rate schedule, incorrect reading of the meter, incorrect connection of the
meter, or other similar reasons, the amount may be refunded or billed to the Customer as the case may be pursuant to Rules 25-30.340 and 25-30.350, Florida Administrative Code.
23.0 ADJUSTMENT OF BILLS FOR METER ERROR - When meter tests are made by the Commission or by the Company, the accuracy of registration of the meter and its performance shall
conform with Rule 25-30.262, Florida Administrative Code and any adjustment of a bill due to a meter found to be in error as a result of any meter test performed whether for unauthorized
use or for a meter found to be fast, slow, non-registering, or partially registering, shall conform with Rule 25-30.340, Florida Administrative Code.
24.0 METER ACCURACY REQUIREMENTS - All meters used by the Company should conform to the provisions of Rule 25-30.262, Florida Administrative Code.
25.0 FILING OF CONTRACTS - Whenever a Developer Agreement or Contract, Guaranteed Revenue Contract, or Special Contract or Agreement is entered into by the Company for the sale of
its product or services in a manner not specifically covered by its Rules and Regulations or approved Rate Schedules, a copy of such contracts or agreements shall be filed with the
Commission prior to its execution in accordance with Rule 25-9.034 and Rule 25-30.550, Florida Administrative Code. If such contracts or agreements are approved by the Commission, a
conformed copy shall be placed on file with the Commission within 30 days of execution.