INDEPENDENT WATER AND SEWER COMPANIES OF TEXAS, INC.

4833 Spicewood Springs Road, Suite 220

Austin, TX 78759

 (512) 346-4011 IWSCOT@austin.rr.com Facsimile (512) 346-6847

APPLICATION FOR MEMBERSHIP

Name of Utility/Company/Firm _________________________

Mailing Address ____________________________________________________________

 City _________________ State ____________ Zip ____________ Phone _____________

Official Representative Name __________________________  Title ___________________

Type of Membership (Check One): ______ Regular (Voting) Membership (Utility Only)

     ______ Associate Member (Trade or Professional)

If Applying for Regular Membership, Indicate number of Customers:

  ___________ Water  ____________ Sewer

Note: Annual dues for regular customers are determined annually and are based on number of customers.

Utility Consultants (If Applicable):

Attorney __________________________ Engineer ____________________________

Accountant ________________________ Rate Specialist ________________________

Referred/Sponsored by: ____________________________________________________

Description of Associate Applicant’s Products or Services:

______________________________________________________________________________

I hereby apply for membership in the Independent Water and Sewer Companies of Texas, Inc.

______________________________________         Date:  _______________

Please mail or fax this application to the address above.  Dues are prorated with annual dues being due as of January 1 of each year.