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 Matrix Lot or Building Number Street Address Fire suppression sprinklers? Irrigation? Building age 1979 or after? Operations Lot or Building Number Street Address Fire suppression sprinklers? Yes No Irrigation? Yes No Building age 1979 or after? Yes No Lot or Building Number Street Address Fire suppression sprinklers? Yes No Irrigation? Yes No Building age 1979 or after? Yes No Lot or Building Number Street Address Fire suppression sprinklers? Yes No Irrigation? Yes No Building age 1979 or after? Yes No Lot or Building Number Street Address Fire suppression sprinklers? Yes No Irrigation? Yes No Building age 1979 or after? Yes No Lot or Building Number Street Address Fire suppression sprinklers? Yes No Irrigation? Yes No Building age 1979 or after? Yes No Add Comments Submit