PWCSA: Request for New Service

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Request for New Service

Disclaimer

PRIVACY

As a PWCSA customer, your privacy is of the utmost importance. The information in our customer records has always remained confidential and has never been sold. Information gathered via the PWCSA Internet site would likewise not be sold or used outside our company. Information provided by visitors to the PWCSA Internet site and gathered from server records about visitors may be used internally by PWCSA to enhance the efficiency and usefulness of the site, and within the company's own efforts to improve customer service. Information from any internal customer records may, on occasion, be used to improve customer service.

Despite any representations here or elsewhere within the PWCSA Internet site, PWCSA reserves the right to disclose any information in its possession if required to do so by law or upon a good-faith belief that such action is necessary to comply with the law, to protect or defend the Authority's right or property, or to respond to an emergency situation.

You may apply for water and sewer service with Prince William County Service Authority by completing and submitting your information. The service must be within Prince William County Service Authority's service area. If you have any problems submitting your information or if you have any questions regarding service, please send an e-mail to CUSTOMERSERVICE@PWCSA.ORG or call (703) 335-7950.

You will receive an e-mail acknowledging your submitted information. Please be sure we have your correct telephone number(s) and e-mail address. Respond to all appropriate questions and note the disclaimer on the bottom of the page. Please verify your information carefully prior to submitting.

A $25 Application Fee Will Appear On Your First Bill.

In order to ensure processing and avoid delays, please complete all of the Required Information (*) below.


Customer Information

* First Name:	Middle:	* Last Name:


* E-Mail Address


* Last 4 digits of your Social Security Number:
Or last 4 digits of your Driver's License:

* Primary Number:	* Work Phone:



*REGARDING THE PROPERTY, PLEASE CHECK THE APPROPRIATE BOX
Owner Tenant Agent/Manager

If tenant is checked, the following information is mandatory:

OWNER/LANDLORD

* First Name:	Middle:	* Last Name:


* Street:	* Apt.#: if applicable

* City:	* State:	* Zip Code:


* Primary Number:	Work Phone:	Ext:



SERVICE ADDRESS

* Street:	Apt.#:

* City:	* State:	* Zip Code:


* Primary Number:	Work Phone:	Ext:



BILLING ADDRESS (only if different from service address)

Street:	Apt.#:

City:	State:	Zip Code:


Work Phone:	Ext:



REQUESTED START DATE *
Month Day Year

We do not initiate service on weekends or holidays. Please allow two working days for request to become effective. Work orders for weekends or holidays will be scheduled for the next available business day.


HAVE YOU HAD PREVIOUS SERVICE WITH PWCSA?
Yes No

FORMER ADDRESS:


WHEN DID YOU LIVE THERE? (YEAR)


APPLICATION INFORMATION PROVIDED BY:

* Name:	* Primary Number:


Relationship(if not the customer):



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Disclaimer

PWCSA's forms and other interactive materials on this site utilize conventional Internet e-mail and other communications capabilities. We cannot know when problems arise on the Internet or when equipment incompatibilities distort messages.

Therefore, please understand that: Prince William County Service Authority is not responsible for technical, hardware or software failures of any kind in relation to any use of this Internet site. We are not responsible for incomplete, distorted or delayed computer transmissions. Under no circumstances will PWCSA be liable for damages (including without limitation punitive incidental or consequential damages or loss profits) resulting from the use of the information or interactive forms on this site.

The information and forms on this site are presented "as is" and, to the fullest extent of the law, without warranties of any kind. PWCSA makes no representations or warranties about the merchantability or fitness for any particular purpose of the information contained in the documents and related pictures and graphics on this site.

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