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2. City of Newport News
   Waterworks Department

   700 Town Center Drive, Suite 400
   Newport News, Virginia 23606-4700
   Phone: (757) 926-1101 option 1
   Email: wwnewservice@nnva.gov

4. REQUESTOR INFORMATION
6. Date
   Date
8. Requestor's Name*
10. Parcel Street Number*
11. Parcel Street Name*
13. City/County*
14. State*
15. ZIP*
17. Meter Service Requested*
    -- Select One --ResizeRelocateResize & Relocate
18. Meter Size Requested
    -- Select One --5/8"3/4"1"1.5"2"
20. E-mail*
22. Phone*
24. ACCOUNTHOLDER INFORMATION
26. Accountholder Name*
28. Accountholder Street Number*
29. Accountholder Street Name*
31. City/County*
    -- Select One --HamptonJames City CountyNewport NewsPoquosonYork County
32. State*
    -- Select One --Virginia
33. ZIP
35. Phone*
37. Email
39. Please check Here*

    1. I understand

    You understand that by typing your name below you are electronically signing this document.

40. Signature*

    Please enter your full name here

42. Revised Oct 2021

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44. 1. Receive an email copy of this form.
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