{"id":82407,"date":"2026-07-29T08:03:12","date_gmt":"2026-07-29T12:03:12","guid":{"rendered":""},"modified":"2026-07-29T08:03:12","modified_gmt":"2026-07-29T12:03:12","slug":"mar-application-for-service","status":"publish","type":"page","link":"https:\/\/www.goldenisleslepc.org\/?page_id=82407","title":{"rendered":"MAR Application For Service"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f82401-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"82401\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F82407#wpcf7-f82401-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"82401\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f82401-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:82401,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;}}\" \/>\n<\/fieldset>\n<p>Have you ever had a MAR account with the JWSC before?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-341\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-341[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-341[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p>If yes, account number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-347\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Account Number\" value=\"\" type=\"text\" name=\"text-347\" \/><\/span>\n<\/p>\n<p>What is the purpose of your application? Describe project:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-196\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Describe project\" value=\"\" type=\"text\" name=\"text-196\" \/><\/span>\n<\/p>\n<p>Have you spoken with JWSC staff to request testing?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-374\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-374[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-374[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p>If Yes, Staff Name:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-770\"><input size=\"40\" maxlength=\"40\" minlength=\"2\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Staff Name\" value=\"\" type=\"text\" name=\"text-770\" \/><\/span>\n<\/p>\n<p>What type of MAR account are you requesting?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select-352\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"select-352\"><option value=\"\">Please select an account type<\/option><option value=\"Bacteriological Testing\">Bacteriological Testing<\/option><option value=\"Fire Flow Testing\">Fire Flow Testing<\/option><option value=\"Damages Invoicing\">Damages Invoicing<\/option><option value=\"Septic Hauler\">Septic Hauler<\/option><option value=\"Pretreatment Inspection\">Pretreatment Inspection<\/option><\/select><\/span>\n<\/p>\n<p>Additional Items Needed When Submitting Application:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-571\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-571[]\" value=\"W-9\" \/><span class=\"wpcf7-list-item-label\">W-9<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-571[]\" value=\"Gov&#039;t Issued Photo ID\" \/><span class=\"wpcf7-list-item-label\">Gov&#039;t Issued Photo ID<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p>Applicant Information\n<\/p>\n<p>Corporate or Business Name:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Corporate-or-Business-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Corporate or Business Name\" value=\"\" type=\"text\" name=\"Corporate-or-Business-Name\" \/><\/span>\n<\/p>\n<p>Doing Business As:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Doing-Business-As\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Doing Business As\" value=\"\" type=\"text\" name=\"Doing-Business-As\" \/><\/span>\n<\/p>\n<p>Start Date Of Business:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-94\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-94\" \/><\/span>\n<\/p>\n<p>Business License Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"business-license-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Business License Number\" value=\"\" type=\"text\" name=\"business-license-number\" \/><\/span>\n<\/p>\n<p>City\/County:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city-county\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"City\/County\" value=\"\" type=\"text\" name=\"city-county\" \/><\/span>\n<\/p>\n<p>This Is A:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select-988\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"select-988\"><option value=\"\">Please select one<\/option><option value=\"Corporation\">Corporation<\/option><option value=\"Partnership\">Partnership<\/option><option value=\"Sole Proprietorship\">Sole Proprietorship<\/option><option value=\"LLC\">LLC<\/option><option value=\"PC\">PC<\/option><\/select><\/span>\n<\/p>\n<p>If Corporation or Partnership: (Principal Officers)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-866\"><input size=\"40\" maxlength=\"100\" minlength=\"2\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Principal Officers\" value=\"\" type=\"text\" name=\"text-866\" \/><\/span>\n<\/p>\n<p>Billing Address:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-888\"><textarea cols=\"40\" rows=\"10\" maxlength=\"1000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Street, City, State, Zip or Postal Code\" name=\"textarea-888\"><\/textarea><\/span>\n<\/p>\n<p>Bill Delivery Method:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-782\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"E-Bill is the default delivery method\" value=\"\" type=\"text\" name=\"text-782\" \/><\/span>\n<\/p>\n<p>Primary Phone:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-65\"><input size=\"40\" maxlength=\"16\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"000-000-0000\" value=\"\" type=\"tel\" name=\"tel-65\" \/><\/span>\n<\/p>\n<p>Work or Cell:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-930\"><input size=\"40\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"000-000-0000\" value=\"\" type=\"tel\" name=\"tel-930\" \/><\/span>\n<\/p>\n<p>E-Mail Address (To Send Billing Statement):<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-683\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email Address\" value=\"\" type=\"email\" name=\"email-683\" \/><\/span>\n<\/p>\n<p>E-Mail Address for Test Results:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-632\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" placeholder=\"Email Address\" value=\"\" type=\"email\" name=\"email-632\" \/><\/span>\n<\/p>\n<p>Responsible Party (Owner\/Officer):<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-939\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name: Last, First, Middle\/Maiden\" value=\"\" type=\"text\" name=\"text-939\" \/><\/span>\n<\/p>\n<p>Date of Birth:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-598\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-598\" \/><\/span>\n<\/p>\n<p>Driver's License #:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-980\"><input size=\"40\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Driver&#039;s License Number\" value=\"\" type=\"text\" name=\"text-980\" \/><\/span>\n<\/p>\n<p>State:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-357\"><input size=\"40\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"State\" value=\"\" type=\"text\" name=\"text-357\" \/><\/span>\n<\/p>\n<p>Additional Person Authorized on Account (No Signature Required):<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-16\"><input size=\"40\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name\" value=\"\" type=\"text\" name=\"text-16\" \/><\/span>\n<\/p>\n<p>Septic Hauler Truck Information\n<\/p>\n<p>Septic Hauler Truck Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-248\"><input size=\"40\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Truck Number\" value=\"\" type=\"text\" name=\"text-248\" \/><\/span>\n<\/p>\n<p>Septic Hauler Tank Capacity:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-21\"><input size=\"40\" maxlength=\"1000\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Tank Capacity\" value=\"\" type=\"text\" name=\"text-21\" \/><\/span>\n<\/p>\n<p>Septic Hauler Tag Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-967\"><input size=\"40\" maxlength=\"100\" minlength=\"2\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Tag Number\" value=\"\" type=\"text\" name=\"text-967\" \/><\/span>\n<\/p>\n<p>Additional Hauler Truck Information\n<\/p>\n<p>Septic Hauler Truck Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-248\"><input size=\"40\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Truck Number\" value=\"\" type=\"text\" name=\"text-248\" \/><\/span>\n<\/p>\n<p>Septic Hauler Tank Capacity:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-21\"><input size=\"40\" maxlength=\"1000\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Tank Capacity\" value=\"\" type=\"text\" name=\"text-21\" \/><\/span>\n<\/p>\n<p>Septic Hauler Tag Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-967\"><input size=\"40\" maxlength=\"100\" minlength=\"2\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Tag Number\" value=\"\" type=\"text\" name=\"text-967\" \/><\/span>\n<\/p>\n<p>Document Uploads\n<\/p>\n<p>Required Documents:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-240\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.doc,.docx\" aria-invalid=\"false\" type=\"file\" name=\"file-240\" \/><\/span>\n<\/p>\n<p>Additional Document 1:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"additional-document-1\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.doc,.docx\" aria-invalid=\"false\" type=\"file\" name=\"additional-document-1\" \/><\/span>\n<\/p>\n<p>Additional Document 2:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"additional-document-2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.doc,.docx\" aria-invalid=\"false\" type=\"file\" name=\"additional-document-2\" \/><\/span>\n<\/p>\n<p>Additional Comments\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-comments\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Enter any additional comments, questions, or information you would like to provide.\" name=\"additional-comments\"><\/textarea><\/span>\n<\/p>\n<p>The undersigned hereby request provision of service by Brunswick-Glynn Joint Water and Sewer Commission, as described hereon, for which I agree to pay when invoiced at the scheduled rate then in effect when due. I will comply with the rules and regulations of the JWSC making them a part of this agreement. In the event of default of payment, the ordinances of the JWSC will apply and any fees assessed for such default will be my responsibility. If I fail to comply with this agreement, or any part thereof, the JWSC may withhold testing results, discontinue sewer services to the premises without notice to me, and\/or refer the delinquent account to a third-party debt collection service. The JWSC reserves the right to contact the applicant hereon at any of the project locations described herein.\n<\/p>\n<p>Signature of Applicant:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-316\"><input size=\"40\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Applicant Name\" value=\"\" type=\"text\" name=\"text-316\" \/><\/span>\n<\/p>\n<p>Date:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-478\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-478\" \/><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit Application\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"178\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":757,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-82407","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.goldenisleslepc.org\/index.php?rest_route=\/wp\/v2\/pages\/82407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.goldenisleslepc.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.goldenisleslepc.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.goldenisleslepc.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.goldenisleslepc.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=82407"}],"version-history":[{"count":0,"href":"https:\/\/www.goldenisleslepc.org\/index.php?rest_route=\/wp\/v2\/pages\/82407\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.goldenisleslepc.org\/index.php?rest_route=\/wp\/v2\/pages\/757"}],"wp:attachment":[{"href":"https:\/\/www.goldenisleslepc.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=82407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}