1 Start 2 Complete By submitting this form, I hereby certify that I am the property owner and, to the best of my knowledge, the information provided is true and accurate. The form is not intended for urgent requests or emergency assistance. If you require same day assistance or if this is an emergency such as a frozen meter, water quality concern or no access to water please call our Customer Relations team during regular business hours at 571-291-7880 or our after-hours emergency number at 571-291-7878. For more information about Loudoun Water’s commitment to keeping lead of out of our drinking water, visit https://www.loudounwater.org/residential-customers/keeping-lead-out. Please Enter Your Contact Information Name * Account Number * Address 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 * Phone Email Address * Uploading Supporting Documents and Photos Add a new file Upload More informationFiles must be less than 5 MB. Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav gz rar zip. Additional Information Select All That Apply I have documentation to verify my private water service line is not lead. I can verify that my private water service line is lead. I have concerns that my private water service line may be lead. I would like a representative to contact me to discuss my private water service line. Comments Leave this field blank Submit
