Utility Arrearage Assistance Customer Intake Form(ONLY active Newport News Waterworks customers need apply. (*Assistance will be available until funds have been depleted*)
General Information (All Applicants fill in this section.)
Only Non-Residential Applicants fill in this section, i.e. business locations, business owners, religious facilities, etc.
CSR Rep Name Here
This field is not part of the form submission.
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