1 Start 2 Complete Welcome to the neighborhood! Please fill out the form below to start service with Loudoun Water. To make sure your residence or business is in our service area, view our Service Area map. If you have any problems submitting your information or if you have any questions regarding service, please call 571-291-7880. We need a minimum of 24 hours notice to start service Monday-Friday and we are closed on weekends and holidays. Call us by 5:00 p.m. on a Friday to start service on a Monday. This form is intended for new customers. Please make sure you familiarize yourself with the Customer Handbook and Loudoun Water’s Rates, Rules and Regulations. If your service has been disrupted, please contact Customer Relations at 571-291-7880 to provide confirmation of a payment. Regarding the property, you will be the: * - Select -OwnerTenantListing AgentProperty ManagerFor Homeowners with Tenants: Property owners will be required to complete the Homeowner Authorization Form - PRIOR to Loudoun Water providing water and sewer service at their property location to a tenant. For All Tenants: Tenants will be required to pay a Tenant Advance Payment fee of $200.00 before new service will be provided. The advance payment fee will be held until the tenant's account is closed and then applied to the final bill. We are unable to waive the advance payment fee for tenants unless they provide documentation as requested in 15.2-2119 and 15.2-5139 Code of Virginia relating to fees for water and sewer systems Section H. Please call our Customer Relations department at 571-291-7880 to set up your account. Property Manager Information First Name * Middle Last Name * Primary Phone * Work Phone * Email Address: * Owner Information First Name * Middle Last Name * Primary Phone: * Work Phone Birth Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year19141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Year Email Address * Service Address Before submitting a request to start service, view our service area map to confirm that Loudoun Water services your address. Address 1 * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip code * Primary Phone * Work Phone Work Phone Ext. Billing Address (if different from the service address) Address 1 Address 2 City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip code Primary Phone Work Phone Work Phone Ext. Former Owner Name Start Service Date We need a minimum of 24 hours notice to start service Monday-Friday and we are closed on weekends and holidays. Call us by 5 pm on a Friday to start service on a Monday. MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20222023202420252026 Year Start Service Date: Did you have previous service with Loudoun Water - None -YesNo Former Address What year did you live there? Information Provided By: Name * Primary Number * Relationship (if not the customer) Do you have any of the following on your property? Irrigation system Swimming pool Fire line Do you wish to receive Periodic Communications from Loudoun Water? Do you wish to receive Periodic Communications from Loudoun Water? I have read and understand the Privacy and Terms of Use Agreement I have read and understand the Privacy and Terms of Use Agreement * If you are the listing agent, please call our Customer Relations department at 571-291-7880 to provide the Listing Agreement and Tenant Advance Payment fee of $200, which is required of all tenants before new service will be provided. Leave this field blank Submit
