1 Start 2 Complete Starting January 1, 2024 All New Hydrant Meter Requests Need to be Filled Out on This Form Why Do You Need a Hydrant Meter? * Truck/Tank Fill Landscaping Construction Water Masonry Facility Commissioning/Testing Temporary Sanitary Sewer Discharge Other Number of Tanks/Trucks? Describe the Use of the Hydrant Meter Provide Project Address Enter Your Loudoun Water Project ID #. Enter the Loudoun Water Inspectors Name (If Available) - None -Jay BaltzerTimothy BowlesMichael BurrowsKaleb DanBradley FlemingJason FranklinRobb GouldWilliam"Tanner" MadiganBryan MontgomeryAaron MoviusMatt OwensMatt ParksGary PateMike SanfordSidney "JJ" VirtsWesley Walker Do You Have a Backflow Protection? * Yes (Air Gap) Yes (RPZ) No What Meter Size Do You Need? * 3 inch ($1720) 3/4 ($400) Estimated Duration of Project (Provide an Estimated End Date) * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20232024202520262027202820292030203120322033 Year Billing Information Company Name * 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 * Company Phone * Company Email * Contact Person Information Company * Contact Person (Name and Title) * Mailing Address (If Different from Billing Address) City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Contact Person Work Phone * Contact Person Mobile Phone Contact Person Email * Additional Contact Person Information Name Email Address File Upload Please Upload the Following Files: Valid, State Issued Identification Card (ie: Driver's License) Business Card (Including the Company Name and the Name of the Person Picking Up the Hydrant Meter) Business License - Virginia or Loudoun County Copy of your Federal Tax Identification Number (Copy of your W-9) Valid, State Issued Identification Card * Upload 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 mp3. Business Card * Upload 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 mp3. Business License * Upload 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 mp3. Copy of Your Federal Tax Identification Number (W-9) * Upload 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 mp3. After submission of this form, a confirmation email is automatically sent to the requestor. NOTE: If no confirmation email is received within a few minutes, or you experience any issues with the form, please send an email to: HydrantMeterRequest@loudounwater.org Leave this field blank Submit
