Point of Contact Update Form

Update Point of Contact

Water System Name

Water System Federal ID#

Current active number of connections on water system:

NWS would like to make sure that we have the correct & current contact information for the owner, primary and secondary point of contact for the Water System, to do this please submit the form below and please complete the entire form.

Water System OWNER Information

Owner Full Name

Owner E-Mail

Owner Work Phone

Owner Title

Owner Home Phone

Owner Cell Phone

Owner Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Water System PRIMARY CONTACT Information

Primary Contact Full Name

Primary Contact E-Mail

Primary Contact Work Phone

Primary Contact Title

Primary Contact Home Phone

Primary Contact Cell Phone

Primary Contact Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Water System SECONDARY CONTACT Information

Secondary Contact Full Name

Secondary Contact Title

Secondary Contact E-Mail

Secondary Contact Work Phone

Secondary Contact Home Phone

Secondary Contact Cell Phone

Secondary Contact Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Water System BILLING CONTACT Information

Billing Contact Full Name

Billing Contact Title

Billing Contact E-Mail

Billing Contact Work Phone

Billing Contact Home Phone

Billing Contact Cell Phone

Billing Contact Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Primary party responsible for treatment system operation & maintenance (If your system has treatment)

Primary Treatment Contact Full Name

Primary Treatment Contact E-Mail

Primary Treatment Contact Title

Primary Treatment Contact Home Phone

Primary Treatment Contact Cell Phone

Secondary party responsible for treatment system operation & maintenance (If your system has treatment)

Secondary Treatment Contact Full Name

Secondary Treatment Contact Title

Secondary Treatment Contact E-Mail

Secondary Treatment Contact Home Phone

Secondary Treatment Contact Cell Phone

Thanks for submitting!