1 Start 2 Complete Owner Information (Party who will receive connection charge invoice) Builder/Owner Company Name * Mailing Address * Contact First Name * Contact Last Name * Phone Number * Email * Consumption Billing Information (Party who will receive consumption/usage bill.) The same as above The same as above Company Name * Mailing Address * Phone Number * Structure to be Serviced Loudoun Water Project ID Number Subdivision * Section or Phase # * Select Type * Residential Commercial / Industrial Multi-Family Other , If Other, specify Other Type * Lot or Building NumberStreet AddressFire suppression sprinklers?Irrigation? Lot or Building Number Street Address Yes No Fire suppression sprinklers? Yes No Irrigation? Lot or Building Number Street Address Yes No Fire suppression sprinklers? Yes No Irrigation? Lot or Building Number Street Address Yes No Fire suppression sprinklers? Yes No Irrigation? Lot or Building Number Street Address Yes No Fire suppression sprinklers? Yes No Irrigation? Add a row Comments Leave this field blank Submit
