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Application for Water Service

  1. Generic Type _ Image Form Web Banner

  2. The Norfolk Department of Utilities provides Norfolk residents and businesses with top-quality water and wastewater collection services, 24 hours per day, 7 days per week, and we take great pride in serving you.

  3. Please complete in its entirety the below request to start or stop services. If you have questions or require assistance in completing this form, please call the Customer Care Office at 757-664-6700 Monday through Friday (excluding holidays) between 7:30 a.m. to 5 p.m. We’re here to help!

  4. The date you'd like to start or stop services. Service requests received by 3 p.m. will be set up the following business day. Norfolk Utilities cannot establish service if the required documents are missing, altered or incomplete.

  5. Are You Requesting to Start or Terminate Services?*

  6. Are You a Previous Customer?

    Have you had a Norfolk Utilities account within your name before?

  7. Account Holder Information

  8. Enter numbers only, including area code

  9. Enter numbers only, including area code

  10. If not employed, enter N/A

  11. Additional Cotenant?

  12. Enter numbers only, including area code

  13. Enter numbers only, including area code

  14. If not employed, enter N/A

  15. Additional Cotenant?

  16. Enter numbers only, including area code

  17. Enter numbers only, including area code

  18. If not employed, enter N/A

  19. Additional Cotenant?

  20. Enter numbers only, including area code

  21. Enter numbers only, including area code

  22. If not employed, enter N/A

  23. Are you renting your home?

  24. Enter numbers only, including area code

  25. Document Uploads

    Please submit the corresponding lease pages that contain the effective date of the lease, the names of the lessee(s) and landlord (usually the 1st page) and the page containing the signature of each responsible party (usually the last page) along with each lessee’s government-issued ID. If you have purchased the property please submit the closing document (1st page) and signature page along with the purchaser's ID.

  26. Names of the lessee(s) and landlord (usually the 1st page)

  27. The page containing the signature of each responsible party (usually the last page)

  28. Lessee's government-issued ID

  29. Certification

    By submitting this application, you are requesting us to open a water account in your name and initiate all associated utility charges. Only individuals 18 or over may open an account. You certify that the information you provide on this application is accurate. You are responsible for all use and charges on your account including use by unauthorized users. Collection of unpaid utility bills will be pursued against both the primary and secondary customers.

  30. Leave This Blank:

  31. This field is not part of the form submission.