Homeowner Authorization Form

1 Start 2 Complete

If you are a Homeowner 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. The advance payment fee assessed is based on the average quarterly cost of service. This practice minimizes the potential payment liability of the property owner.

Homeowner's Billing Address

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.

As Homeowner 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).

You may download and print a copy of the Homeowner Authorization Form. When completed, mail these to Loudoun Water Attn: Customer Service, PO Box 4000, Ashburn, VA 20146 or fax to 571.223.2595. By submitting this web form, I acknowledge that I have read the above statement and agree to the terms listed.