Date Requested Start Date of Water Service Applicant First Name Applicant Last Name Applicant State Issued ID Number Issuing State of ID Co Applicant? YesNo
    Co-Applicant First Name Co-Applicant Last Name Co-Applicant State Issued ID Number Issuing State of ID
    Mailing Address City State Zip Code Email Address Phone Number Alternate Phone Number Water Service Address Same as Mailing Address? YesNo
    Water Service Address City State Zip Code
    Current Status of Water Service OnOffNo ServiceNot Sure Non-typical water uses at the service address (check all that apply) Hot tubIn Ground Sprinkler SystemPoolFish Pond Additional Water Sources at the service (check all that apply) NoneWellSpringCreek/Stream Is the Applicant the owner of the property for which service is being requested? YesNo
    Owner’s First Name Owner’s Last Name Owner’s Phone Number Owner’s Address City State Zip Code

    Service is our priority

    We work directly with NW Natural Water Services to facilitate all support needs. Contact their support line at (503) 554-8333, Monday- Friday from 9AM – 4PM (except holidays) or email us anytime at NWSO-H@nwnaturalwaterservices.com

    • Mailing Address:
      PO Box 699
      Newberg, OR 97132
    • Phone:
      (503) 554-8333
      Toll-Free (855) 554-8333
    • Fax:
      (503) 554-9215
    • Monday - Friday:
      9:00 AM - 4:00 PM