If you are a Commercial owner and wish for a tenant to start service at your property you must complete the below form prior to a tenant starting service. Tenants are required to pay a Tenant Advance Payment fee prior to initiating service. This practice minimizes the potential payment liability of the property owner. Property Manager Name * Commercial Owner's Name * Commercial Owner's Email * Commercial Owner's Billing Address Billing address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP code * Commercial Owner's Phone Number * Service Address The following tenant(s) have entered into a lease agreement for the referenced service address and is(are) authorized to obtain services from Loudoun Water at this address as my tenant(s). Please list the first and last name of each tenant on the lease agreement. Tenant's Name * Tenant's Name * Tenant’s Phone Number * Tenant's Email Address to Start Service * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP code * Estimated Start Service * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202520262027 Year As Commercial Owner of the above mentioned property I am providing the tenants information to confirm they have entered into a lease agreement with me to occupy the property. By completing this form I am authorizing the tenant to obtain services at this address and be added to the account for billing purposes. I understand a Tenant Advance Payment fee will be collected and a Lien can be placed on the property if payment is not received. The property owner is ultimately responsible for payment of all outstanding charges in accordance with Virginia law (Section 15.2-5139, Code of Virginia). By submitting this web form, I acknowledge that I have read the above statement and agree to the terms listed. Leave this field blank Submit
