Tenant Authorization Form Fairfax PDF Details

You will discover details about the type of form you need to fill out in the table. It will tell you how much time you'll need to fill out tenant authorization form fairfax, what fields you need to fill in and several other specific details.

Form NameTenant Authorization Form Fairfax
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesfairfax authorization, fairfax water authorization form, virginia water authorization, fairfax water tenant authorization

Form Preview Example


8570 EXECUTIVE PARK AVENUE FAIRFAX, VA 22031 www.fairfaxwater.org


Please return COMPLETED form to:


Please allow us at least 4 hours, after submission, on a business day, to process your form.

Fax: (703)466-6863

Phone: (703)698-5800

The following information must be completed in full and signed by the legally recorded property owner or authorized agent to establish new service. *If this form is altered it will not be accepted and will cause delays with processing and your tenant starting service. After submission of this form, the new tenant MUST call our Customer Service department to establish service during our normal business hours Monday-Friday between 8:00am and 4:30pm and for further instruction on how to make the Lien Offset payment.

All tenants are required to pay $190 (Lien Offset payment) prior to the service start date. This payment will be applied to the final bill once the tenant has notified Fairfax Water to disconnect service.

Service Address _________________________________________ Service Start Date __________________________

The following tenant(s) have entered into a lease agreement for the referenced service address and is/are authorized to obtain services from Fairfax Water at this address as my tenant(s).

Tenant Information - Please print the first and last name of each tenant (over age 18) on the lease agreement.





Contact Information


Phone ___________________________________

Email _______________________________________

Lien Offset may be waived for tenants who receive need based local, state, or federal rental assistance. If your tenant receives rental assistance, please provide documentation with this form.

Property Owner Information - Please provide first and last name, mailing address (different from the service address), and contact information.

Property Owner or Authorized Agent ___________________________________________

Address _________________________________________________________________

Phone ___________________________________

Email _______________________________________

By signing this form, I acknowledge, as the owner or authorized agent of the service address listed above, I am responsible for any unpaid balance for this account, after Fairfax Water has made a reasonable effort to collect from the aforementioned tenant(s). If signing as an agent, he/she is authorized to endorse this document, on behalf of the owner.

Signature _________________________________________

Date _________________

Property Owner or Authorized Agent


For more information, visit fairfaxwater.org. For one-time payment, visit FWcustomer.org.




Office Use Only




Lien Offset Received





Lien Offset Waived

Amount Received $____________ Account Number ___________________

Received By ___________________

(Updated 2/26/2019)

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Step 1: On this page, select the orange "Get form now" button.

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fairfax county water tenant authorization form spaces to consider

In the segment Property Owner or Authorized Agent, Address, Phone, Email, By signing this form I acknowledge, Signature Property Owner or, Date, For more information visit, Lien Offset Received, Cash, Check, Portal, Speedpay, Lien Offset Waived, and Amount Received Account Number provide the particulars which the program requests you to do.

part 2 to completing fairfax county water tenant authorization form

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