1 Start 2 Complete If you are a Homeowner or a Property Manager 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 an advance payment fee within 48 hours of establishing their account. If your tenant fails to make the payment within 48 hours, the account is then placed in the homeowner's name. 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. Information Provided By: * - Select -HomeownerProperty Manager Property Manager Company Name * Property Manager Name * Property Manager Email Address * Please note that a property management agreement or a letter of authorization is required before we process your Homeowner Authorization Form. Has a Property Management Agreement or Letter of Authorization for This Property, Submitted to Loudoun Water Before? * No Yes Property Management Agreement or Letter of Authorization * Upload Please Upload the Appropriate Files More informationFiles must be less than 40 MB. Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml tar zip. Homeowner's Name * Homeowner's Phone Number * Homeowner's Email * Second Homeowner's Name Second Homeowner's Phone Number Second Homeowner's Email 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 * 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 Phone * Tenant's Email * Second Tenant's Name Second Tenant's Phone Number Second 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 Date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20222023202420252026 Year 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). Loudoun Water maintains an “Owner Status” account for a rental property whether or not the property is occupied by tenants. When the property is rented, the tenant must contact Loudoun Water to open an account and initiate service in their name. This will ensure the tenant is billed directly. Loudoun Water will deactivate the tenant's account when notified by the tenant of their intent to vacate the property or if the homeowner calls to put service back in their name. The account will shift to “Owner Status” and the billing reverts back to the property owner. Service is NOT deactivated; the water remains ON. I acknowledge that, as the owner property, I am responsible for any unpaid balance for this account after Loudoun Water has attempted to collect any outstanding balance from the tenant. 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. I have read and understand the Privacy and Terms of Use Agreement * I have read and understand the Privacy and Terms of Use Agreement * Leave this field blank Submit
